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1、肝素钠肺泡灌洗治疗ALI/ARDS的临床疗效观察王晓珊I肖金石2邵阳市中心医院重症医学科1区摘要：目的探讨肝索钠（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索钠。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（APACHEII）评分、肺泡灌洗液（BALF沖IL・6以及PLT、APTT变化、7d
2、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组氧合指数（01）明显升高（FV0.01）,BALF屮的IL-6>APACHEII评分下降显著。其屮，肝索肺泡灌洗组氧合指数优于肝素雾化组，而IL・6、APACHEII评分较雾化组低（PV0.05）o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。肝索肺泡灌洗组、肝索雾化组、对照组死亡率分别为7.5%,12.5%,26.8%,差异有统计学意义，肝素肺泡灌洗组和肝素雾化组死亡率低于对照组（PV0.05）。结论肝索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
3、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,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
