低分子肝素对ICU脓毒症患者ALI/ARDS氧合指数及炎症反应的影响观察
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摘要
目的:观察低分子肝素(LMWH)对重症监护病房(ICU)脓毒症患者急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)氧合指数(OI)及炎症反应的影响。方法:脓毒症性ALI/ARDS患者64例随机分为对照组(常规治疗+LMWH2 500 U)与观察组(常规治疗+LMWH 5 000 U),每组各32例,均连续治疗7 d。比较两组治疗前后的PaO_2/FiO_2、炎症反应[肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)]、凝血功能[凝血酶原时间(PT)、部分凝血活酶时间(APPT)]、急性生理与慢性健康(APACHE)Ⅱ评分,观察药品不良反应。结果:治疗7 d后,观察组PaO_2/FiO_2较前显著升高,炎症介质(TNF-α、IL-6)水平、APACHEⅡ评分较前显著降低(P <0. 05);且上述指标均明显优于对照组(P <0. 05)。两组凝血功能(PT、APTT)水平治疗前后无显著变化(P> 0. 05);药品不良反应发生率比较,差异无统计学意义(P> 0. 05)。结论:LMWH对ICU脓毒症患者ALI/ARDS的治疗有一定效果,LMWH可以提高机体氧合指数、降低炎症反应和APACHEⅡ评分,对凝血功能无明显影响,临床应用安全有效,值得进一步研究。
Objective: To investigate the effect of low molecular weight heparin( LMWH) on oxygenation index and inflammatory reaction of sepsis patients with acute lung injury/acute respiratory distress syndrome( ALI/ARDS) in intensive care unit( ICU). Methods: Totally 64 sepsis patients with ALI/ARDS in ICU were selected and randomly divided into two groups with32 cases in each,namely the control group( the routine treatment + LMWH 2 500 U) and the observation group( the routine treatment + LMWH 5 000 U). The PaO_2/FiO_2,inflammatory factor levels [tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6)],coagulation function [prothrombin time(PT),activated partial thromboplastin time(APPT)],acute physiology and chronic health evaluation( APACHE) Ⅱ score of the two groups were measured and compared. Results: After the 7-day treatment,the level of PaO_2/FiO_2 was significantly higher in the observation group than that in the control group,while the inflammatory factor levels( TNF-α and IL-6) and the APACHEII score of the observation group were lower than those of the control group( P < 0. 05). The coagulation function( PT and APPT) and the incidence of adverse reactions of the two groups had no significant differences( P > 0. 05). Conclusion: LMWH can effectively and safely increase oxygenation index, reduce inflammatory response and APACHEII score in sepsis patients with ALI/ARDS in ICU without influence on coagulation function,which is worthy of further studies.
Objective: To investigate the effect of low molecular weight heparin( LMWH) on oxygenation index and inflammatory reaction of sepsis patients with acute lung injury/acute respiratory distress syndrome( ALI/ARDS) in intensive care unit( ICU). Methods: Totally 64 sepsis patients with ALI/ARDS in ICU were selected and randomly divided into two groups with32 cases in each,namely the control group( the routine treatment + LMWH 2 500 U) and the observation group( the routine treatment + LMWH 5 000 U). The PaO_2/FiO_2,inflammatory factor levels [tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6)],coagulation function [prothrombin time(PT),activated partial thromboplastin time(APPT)],acute physiology and chronic health evaluation( APACHE) Ⅱ score of the two groups were measured and compared. Results: After the 7-day treatment,the level of PaO_2/FiO_2 was significantly higher in the observation group than that in the control group,while the inflammatory factor levels( TNF-α and IL-6) and the APACHEII score of the observation group were lower than those of the control group( P < 0. 05). The coagulation function( PT and APPT) and the incidence of adverse reactions of the two groups had no significant differences( P > 0. 05). Conclusion: LMWH can effectively and safely increase oxygenation index, reduce inflammatory response and APACHEII score in sepsis patients with ALI/ARDS in ICU without influence on coagulation function,which is worthy of further studies.
引文
1孙骆峰,陈兴祥.枸橼酸局部抗凝在脓毒症急性肾损伤患者血液滤过中抗凝作用观察[J].中国药师,2017,20(5):848-850
2魏军,王艳红,冯冬青,等.小剂量肝素对脓毒症患者凝血功能及血小板活化的影响与临床疗效[J].血栓与止血学,2015,21(2):94-97
3黄梅娟,薛加玲,于维松.替加环素相关凝血功能障碍文献概述[J].中国药师,2017,20(11):2046-2048
4伍峻松,易建华,盛蕾,等.影响严重多发伤并发急性肺损伤及急性呼吸窘迫综合征患者生存率危险因素分析[J].中华医学杂志,2006,86(11):753-758
5谢念林,曹祥,严四军,等.不同剂量LMWH雾化吸入对急性肺损伤/急性呼吸窘迫综合征的作用[J].中华肺部疾病杂志(电子版),2014,7(2):182-185
6高少伟.不同剂量LMWH雾化吸入治疗急性肺损伤/急性呼吸窘迫综合征的研究[J].现代中西医结合杂志,2014,23(22):2481-2482
7 Hofstra JJ,Vlaar APJ,Prins DJ,et al.Early intravenous unfractionated heparin and outcome in acute lung injury and acute respiratory distress syndrome-αretrospective propensity matched cohort study[J].BMC Pulmonary Medicine,2012,12(1):1-8
8蒋金泉,李俊杰,魏桂枝,等.炎症反应在急性肺损伤中的作用机制研究进展[J].临床急诊杂志,2017,27(8):1401-1403
9熊丽红,郑晓英,陈伟峰,等.脓毒症患者并发急性肺损伤危险因素分析[J].实用医学杂志,2011,18(3):185-189
10何超,黄增相,陶骅,等.严重脓毒症性急性呼吸窘迫综合征患者血管外肺水的变化以及乌司他丁的作用[J].中国呼吸与危重监护杂志,2015,14(3):291-294
11 Burbeto PD,Seam N,Groot S,et al.Rapid induction of autoantibodies during ARDS and septic shock[J].Journal of Translational Medicine,2010,8(1):1-9
12査佳安,方长太,梅玲,等.LMWH雾化吸入治疗ALI/ARDS的临床疗效观察[J].安徽医药,2012,16(9):1335-1337
13姜平.LMWH治疗对脓毒症患者急性肺损伤/急性呼吸窘迫综合征的影响[J].药物与化验,2017,10(39):70-71
14 Müller MC,Van SD,Binnekade JM,et al.Low-risk transfusion-related acute lung injury donor strategies and the impact on the onset of transfusion-related acute lung injury:a meta-analysis[J].Transfusion,2015,55(1):164-175
15梁久红,邹子俊.LMWH治疗脓毒症急性肺损伤/急性呼吸窘迫综合征的疗效观察[J].临床医学工程,2016,23(8):1029-1030
16王静霞.LMWH治疗脓毒症急性肾损伤患者的临床疗效及对预后的影响[J].中国农村卫生事业管理,2016,36(3):407-407
17叶媛媛,张伟,黄虎翔,等.严重脓毒症性急性呼吸窘迫综合征血管外肺水的变化以及乌司他丁的作用分析[J].临床肺科杂志,2016,21(12):2264-2267
18雷南凤,张伟强.不同剂量低分子肝素雾化吸入治疗急性肺损伤的效果观察[J].北方药学,2016,13(6):113-114
2魏军,王艳红,冯冬青,等.小剂量肝素对脓毒症患者凝血功能及血小板活化的影响与临床疗效[J].血栓与止血学,2015,21(2):94-97
3黄梅娟,薛加玲,于维松.替加环素相关凝血功能障碍文献概述[J].中国药师,2017,20(11):2046-2048
4伍峻松,易建华,盛蕾,等.影响严重多发伤并发急性肺损伤及急性呼吸窘迫综合征患者生存率危险因素分析[J].中华医学杂志,2006,86(11):753-758
5谢念林,曹祥,严四军,等.不同剂量LMWH雾化吸入对急性肺损伤/急性呼吸窘迫综合征的作用[J].中华肺部疾病杂志(电子版),2014,7(2):182-185
6高少伟.不同剂量LMWH雾化吸入治疗急性肺损伤/急性呼吸窘迫综合征的研究[J].现代中西医结合杂志,2014,23(22):2481-2482
7 Hofstra JJ,Vlaar APJ,Prins DJ,et al.Early intravenous unfractionated heparin and outcome in acute lung injury and acute respiratory distress syndrome-αretrospective propensity matched cohort study[J].BMC Pulmonary Medicine,2012,12(1):1-8
8蒋金泉,李俊杰,魏桂枝,等.炎症反应在急性肺损伤中的作用机制研究进展[J].临床急诊杂志,2017,27(8):1401-1403
9熊丽红,郑晓英,陈伟峰,等.脓毒症患者并发急性肺损伤危险因素分析[J].实用医学杂志,2011,18(3):185-189
10何超,黄增相,陶骅,等.严重脓毒症性急性呼吸窘迫综合征患者血管外肺水的变化以及乌司他丁的作用[J].中国呼吸与危重监护杂志,2015,14(3):291-294
11 Burbeto PD,Seam N,Groot S,et al.Rapid induction of autoantibodies during ARDS and septic shock[J].Journal of Translational Medicine,2010,8(1):1-9
12査佳安,方长太,梅玲,等.LMWH雾化吸入治疗ALI/ARDS的临床疗效观察[J].安徽医药,2012,16(9):1335-1337
13姜平.LMWH治疗对脓毒症患者急性肺损伤/急性呼吸窘迫综合征的影响[J].药物与化验,2017,10(39):70-71
14 Müller MC,Van SD,Binnekade JM,et al.Low-risk transfusion-related acute lung injury donor strategies and the impact on the onset of transfusion-related acute lung injury:a meta-analysis[J].Transfusion,2015,55(1):164-175
15梁久红,邹子俊.LMWH治疗脓毒症急性肺损伤/急性呼吸窘迫综合征的疗效观察[J].临床医学工程,2016,23(8):1029-1030
16王静霞.LMWH治疗脓毒症急性肾损伤患者的临床疗效及对预后的影响[J].中国农村卫生事业管理,2016,36(3):407-407
17叶媛媛,张伟,黄虎翔,等.严重脓毒症性急性呼吸窘迫综合征血管外肺水的变化以及乌司他丁的作用分析[J].临床肺科杂志,2016,21(12):2264-2267
18雷南凤,张伟强.不同剂量低分子肝素雾化吸入治疗急性肺损伤的效果观察[J].北方药学,2016,13(6):113-114