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1、旺素钠肺泡灌洗治疗ALI/ARDS的临床疗效观察王晓珊I肖金石2邵阳市屮心医院重症医学科1区摘要:目的探讨肝素钠(UFH)肺灌洗治疗急性肺损伤的临床疗效及可能的作用机制。方法选择120例急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的患者,随机分为对照组、肝素肺泡灌洗组和肝素雾化组。对照组:使用常规治疗基础上行生理盐水肺灌洗;肝素肺泡灌洗组:常规治疗基础上行肝素钠盐水肺灌洗;肝素雾化组:在常规治疗基础上行气道雾化吸入肝素钠。观察和比较3组患者治疗7d后氧合指数、急性生理学与慢性健康状况II(APACHE11)评分、肺泡灌洗液(BALF)中
2、IL・6以及PLT、APTT变化、7d死亡率。结果各组治疗7d后各项指标较前有好转,肝素肺泡灌洗组和肝素雾化组较对照纽•氧合指数(01)明显升高(P<0.01),BALF屮的IL・6、APACHEII评分下降显著。其屮,肝素肺泡灌洗纽氧合指数优于肝素雾化纽,而IL-6.APACHEII评分较雾化组低(尸<0.05)。肝素肺泡灌洗和肝素雾化治疗后PLT、APTT与对照组比较无差异。肝素肺泡灌洗组、肝素雾化组、对照组死亡率分别为7.5%,12.5%,26.8%,差异有统计学意义,肝索肺泡灌洗组和肝索雾化组死广率低于对照组(尸V0.05)。结论肝索
3、肺灌洗和肝素雾化吸入治疗ALI/ARDS,能够改善氧合;抑制IL・6等炎症介质的释放,降低炎症反应,从而降低患者的死亡率。关键词:肝素钠;肺泡灌洗;急性肺损伤/急性呼吸窘迫综合征Aclinicalstudyonacutelunginjury/acuterespiratorydistresssyndrometreatedwiththeunfractionedheparinbronchialalveolarlavageWANGxiaoshan,XIAOjinshiIntensivemedicine1wardShaoyangCentralHospi
4、tal,shaoyang422800,chinaAbstract:ObjectiveToinvestigatetheeffectandpossiblemechanismbronchialalveolarlavagewithunfractionedheparininALI/ARDSpatientsmethodsAtotalof120ALI/ARDSpatientswererandomlydividedintocontrolgroup,BALgroup,atomizationggroup.Patientsinthecontrolgroupwere
5、treatedwithroutinetherapy-PatientsinBALgroupandatomizationgrouprespectivelyreceivedunfractionedheparinbronchialalveolarlavageandultrasionicatomizinginhalationofUnfractionedheparinbasedonroutinetherapy.weobservedandcomparedthethreegroupswith7doxygenindex,APACHEIIscoresJL-6le
6、velofBALFandPLT,APTTchange,and7dmortality.ResultThe7dindexesofthreegroupthreegroupswerebetterthanbefore,anticoagulationgroup(BALgroupandatomizationgroup)werebetterthancontrolgroup.TheoxygenofBALgroupwasbetterthanthatofatomizationgroup.whileBALFIL-6levelandAPACHEIIscoresofBA
7、Lgroupwerelowerthanthoseofatomizationgroup.PLTandAPTTofthethreegroupshadnosignificantdifferenceduringpreandprotreatments.themortalityratesofBALgroup,atomizationggroup,controlgroupwere7.5%,12.5%and26.8%,respectively.Therewasdifferencebetweenthethreegroups,anticoagulationgrou
8、pwasbetterthancontrolgi*oup.ConlusionItwasprovedthatUFHbronchialalveolarlavageresu