早期使用肝素对急性呼吸窘迫综合征患者预后相关指标的影响

Effects of the Early Use of Heparin on the Prognosis Related Indicators of Patients with Acute Respiratory Distress Syndrome

目的:探讨早期使用肝素对急性呼吸窘迫综合征(ARDS)患者预后相关指标的影响。方法 :回顾性分析86例ARDS患者的资料,按是否早期使用肝素分为对照组(41例)和观察组(45例)。对照组患者行有创机械通气,采用呼气末正压(PEEP)通气法,肠内营养支持,鼻饲肠内营养混悬液35~40 kcal/(kg·d);合并感染者给予注射用头孢唑肟钠2 g,加入0.9%氯化钠注射液100m L,静脉滴注,每日2次。观察组患者在对照组治疗的基础上给予肝素钠注射液6 250单位,持续静脉泵入。两组疗程均为14 d。观察两组患者弥散性血管内凝(DIC)累积发生率,治疗前与治疗3、7、14 d后D-二聚体、血小板计数(PLT),治疗前后白细胞介素6(IL-6)、IL-8、IL-10、肿瘤坏死因子α(TNF-α)水平及不良反应发生情况。结果:观察组患者DIC累积发生率显著低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者D-二聚体、PLT、IL-6、IL-8、IL-10、TNF-α水平比较,差异均无统计学意义(P>0.05)。治疗后,两组患者D-二聚体、IL-6、IL-8、TNF-α水平均显著高于同组治疗前,但观察组显著低于对照组;两组患者PLT均显著低于同组治疗前,但观察组显著高于对照组,差异均有统计学意义(P<0.05);两组患者治疗前后IL-10水平比较,差异无统计学意义(P>0.05)。两组患者治疗期间均未见明显不良反应发生。结论:在常规治疗的基础上,早期使用肝素可显著降低ARDS患者的DIC发生风险,改善凝血功能,降低炎症反应水平,且未增加不良反应的发生。

OBJECTIVE：To explore the effects of the early use of heparin on the prognosis related indicators of patients with acute respiratory distress syndrome（ARDS）. METHODS：Data of 86 ARDS patients were retrospectively analyzed and divided into observation group（45 cases）and control group（41 cases）by whether the early use of heparin. Control group received invasive mechanical ventilation,using end-expiratory pressure（PEEP）ventilation method,enteral nutrition support,nasogastric enteral nutrition suspension 35-40 kcal/（kg·d）;patients with combined infection were given Sodium ceftizoxime for injection 2 g,adding into 0.9% Sodium chloride injection 100 m L by intravenously infused,twice a day. Observation group was additionally given Heparin sodium injection 6 250 units by continuous intravenously pumped. They were treated for 14 d. The cumulative incidence of disseminated intravascular coagulation（DIC）,and D-dimer,platelet count（PLT）before treatment and after 3,7,14 d of treatment,IL-6,IL-8,IL-10,TNF-α levels before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS：The cumulative incidence of DIC in observation group was significantly lower than control group,with statistical significance（P〈0.05）. Before treatment,there were no significant differences in the D-dimer,PLT,IL-6,IL-8,IL-10,TNF-α levels,with no statistical significance（P〉0.05）. After treatment,D-dimer,IL-6,IL-8 and TNF-α levels in 2 groups were significantly higher than before,while observation group was significantly lower than control group;PLT in 2 groups was significantly lower than before,while observaton group was higher than control group,with statistical significance（P〈0.05）. There was no significant difference in the IL-10 level in 2 groups before and after treatment（P〉0.05）. And there were no obvious adverse reactions during treatment. CONCLUSIONS：Based on conventional treatment,early use of heparin can significantly decrease the DIC rick for ARDS patients,which can improve coagulation disorders,reduce inflammatory response,and dose not increase the incidence of adverse reactions.