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1、肝素鈉肺泡灌洗治療ALI/ARDS的臨床療效觀察王曉珊I肖金石2邵陽市中心醫(yī)院重癥醫(yī)學(xué)科1區(qū)摘要：目的探討肝索鈉（UFH）肺灌洗治療急性肺損傷的臨床療效及可能的作用機(jī)制。方法選擇120例急性肺損傷/急性呼吸窘迫綜合征（ALI/ARDS）的患者，隨機(jī)分為對照組、肝素肺泡灌洗組和肝素霧化組。對照組：使用常規(guī)治療基礎(chǔ)上行生理鹽水肺灌洗；肝素肺泡灌洗組：常規(guī)治療基礎(chǔ)上行肝素鈉鹽水肺灌洗；肝素霧化組：在常規(guī)治療基礎(chǔ)上行氣道霧化吸入肝索鈉。觀察和比較3組患者治療7d后氧合指數(shù)、急性生理學(xué)與慢性健康狀況II（APACHEII）評分、肺泡灌洗液（BALF沖IL?6以及PLT、APTT變化、7d
2、死亡率。結(jié)果各組治療7d后各項指標(biāo)較前有好轉(zhuǎn)，肝素肺泡灌洗組和肝素霧化組較對照組氧合指數(shù)（01）明顯升高（FV0.01）,BALF屮的IL-6>APACHEII評分下降顯著。其屮，肝索肺泡灌洗組氧合指數(shù)優(yōu)于肝素霧化組，而IL?6、APACHEII評分較霧化組低（PV0.05）o肝素肺泡灌洗和肝素霧化治療后PLT、APTT與對照組比較無差異。肝索肺泡灌洗組、肝索霧化組、對照組死亡率分別為7.5%,12.5%,26.8%,差異有統(tǒng)計學(xué)意義，肝素肺泡灌洗組和肝素霧化組死亡率低于對照組（PV0.05）。結(jié)論肝索肺灌洗和肝素霧化吸入治療ALI/ARDS,能夠改善氧合；抑制IL?6等炎癥介
3、質(zhì)的釋放，降低炎癥反應(yīng)，從而降低患者的死亡率。關(guān)鍵詞：肝素鈉；肺泡灌洗；急性肺損傷/急性呼吸窘迫綜合征Aclinicalstudyonacutelunginjury/acuterespiratorydistresssyndrometreatedwiththeunfractionedheparinbronchialalveolarlavageWANGxiaoshan,XIAOjinshiIntensivemedicine1wardShaoyangCentralHospital,shaoyang422800,chinaAbstract：ObjectiveToinvestigatet
4、heeffectandpossiblemechanismbronchialalveolarlavagewithunfractionedheparininALI/ARDSpatientsmethodsAtotalof120ALI/ARDSpatientswererandomlydividedintocontrolgroup,BALgroup,atomizationggroup.Patientsinthecontrolgroupweretreatedwithroutinetherapy.PatientsinBALgroupandatomizationgrouprespectivel
5、yreceivedunfractionedheparinbronchialalveolarlavageandultrasionicatomizinginhalationofUnfractionedheparinbasedonroutinetherapy.weobservedandcomparedthethreegroupswith7doxygenindex,APACHEIIscores,IL?6levelofBALFandPLT,APTTchange,and7dmortality?ResultThe7dindexesofthreegroupthreegroupswerebett
6、erthanbefore,anticoagulationgroup(BALgroupandatomizationgroup)werebetterthancontrolgroup.TheoxygenofBALgroupwasbetterthanthatofatomizationgroup.whileBALFIL-6levelandAPACHEIIscoresofBALgroupwerelowerthanthoseofatomizationgroup.PLTandAPTTofthethreegroupshadnosignificantdifferenceduringpreandpr
7、otreatments.themortalityratesofBALgroup,atomizationggroup,controlgroupwere7.5%,12.5%and26.8%,respectively.Therewasdifferencebetweenthethreegroups,anticoagulationgroupwasbetterthancontrolgroup.ConlusionItwasprovedthatUFHbronchialalveolarlavageresult
