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目的观察低分子肝素(LMWH)治疗急性呼吸窘迫综合征(ARDS)的临床效果。方法ARDS患者62例随机分为两组:C组30例,予以原发病治疗、机械通气和广谱抗生素等常规治疗;L组32例,加用LMWH 4100U皮下注射,每天1次,连续7d。比较两组患者治疗前后血气分析、凝血指标和血管外肺水指数(EVLWI)变化,行急性生理与慢性健康评分(APACHEⅡ),统计ICU住院时间和28-d病死率。结果治疗后,L组氧合指数、EVLWI和APACHEⅡ评分的改善均优于C组(P<0.05);两组患者治疗前后血小板、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(Fib)均无统计学差异(P>0.05);仅L组治疗第7天的PT长于C组(P<0.05)。L组住ICU时间短于C组(P<0.05);L组28-d病死率稍低于C组(P>0.05)。Logistic回归分析显示,EVLWI和APACHEⅡ评分是ARDS患者死亡的独立影响因素。结论在常规治疗基础上加用LMWH可增强对ARDS的疗效。
Objective To observe the clinical effect of low molecular weight heparin (LMWH) on acute respiratory distress syndrome (ARDS). Methods Sixty-two ARDS patients were randomly divided into two groups: group C (n = 30) received routine therapy such as primary disease, mechanical ventilation and broad-spectrum antibiotics. In group L, 32 cases were treated with LMWH 4100U subcutaneously once daily for 7 days . The changes of blood gas analysis, coagulation index and extravascular lung water index (EVLWI) were compared between the two groups before and after treatment. The acute physiology and chronic health score (APACHEⅡ), the hospitalization time of ICU and the 28-day mortality were compared. Results After treatment, the improvement of oxygenation index, EVLWI and APACHEⅡscore in group L were better than that in group C (P <0.05). The platelet, prothrombin time (PT), activated partial thromboplastin time (APTT ) And fibrinogen (Fib) had no statistical difference (P> 0.05). Only the PT of L group on the 7th day was longer than that of the C group (P <0.05). The ICU stay in L group was shorter than that in C group (P <0.05). The 28-d mortality in L group was slightly lower than that in C group (P> 0.05). Logistic regression analysis showed that the EVLWI and APACHE II scores were independent factors of death in patients with ARDS. Conclusion The addition of LMWH on the basis of routine treatment can enhance the efficacy of ARDS.