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

发布时间：2018-03-06 22:18

本文选题：急性呼吸窘迫综合征　切入点：肝素　出处：《中国药房》2017年06期 　论文类型：期刊论文

【摘要】：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(P0.05)。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(P0.05)。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(P0.05);两组患者治疗前后IL-10水平比较,差异无统计学意义(P0.05)。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。
[Abstract]:Objective: to investigate the effect of early heparin use on prognostic indexes in patients with acute respiratory distress syndrome (ARDS). Methods: the data of 86 patients with ARDS were retrospectively analyzed. According to whether early use of heparin was used, 41 cases in control group and 45 cases in observation group were divided into two groups. Patients in control group were treated with invasive mechanical ventilation, positive end expiratory pressure (PEEP) ventilation and enteral nutrition support. The patients in the observation group were given cefazoxime sodium for injection 2 g, 0.9% sodium chloride injection 100ml, intravenous drip twice a day, and heparin sodium injection 6 250 units on the basis of the treatment in the control group, the patients in the observation group were given heparin sodium injection for 6 250 units on the basis of the treatment in the control group. The cumulative incidence of disseminated intravascular coagulation (DICs) in both groups was observed, and the D- dimer was observed before and after treatment for 3 ~ 7 ~ 14 days. Before and after treatment, the levels of IL-10, TNF- 伪 and TNF- 伪 (tumor necrosis factor 伪) were significantly lower in the observation group than in the control group, and the difference was statistically significant before and after treatment. There was no significant difference in the levels of IL-10 and TNF- 伪 between the two groups. After treatment, the levels of IL-6, IL-8 and TNF- 伪 in the two groups were significantly higher than those in the control group, but those in the observation group were significantly lower than those in the control group. The PLT of the two groups was significantly lower than that of the same group before treatment, but that of the observation group was significantly higher than that of the control group, and the difference was statistically significant (P 0.05). There was no significant difference between the two groups (P 0.05). There were no significant adverse reactions in both groups. Conclusion: on the basis of routine therapy, early use of heparin can significantly reduce the risk of DIC and improve coagulation function in patients with ARDS. The level of inflammatory reaction was decreased, and the occurrence of adverse reaction was not increased.
【作者单位】：四川省医学科学院/四川省人民医院急诊ICU;
【分类号】：R563.8

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