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目的:探讨肝素早期干预防治急性呼吸窘迫综合征(ARDS)患者凝血功能异常的临床效果。方法:将162例ARDS患者随机分为2组,其中对照组73例,肝素组89例。对照组给予常规治疗(包括维护脏器功能、手术干预、机械通气、抗感染、营养支持等)。肝素组给予常规治疗+肝素,肝素每天剂量为6 250~18 750U,将凝血酶原时间(PT)和活化部分凝血酶时间(APTT)控制在正常值的2~3倍,并根据PT和APTT复查的结果调整肝素的用量,连续7~14d。所在转入ICU后第1天、第3天、第7天、第14天查PLT、D-二聚体;统计2组第14天病死率。结果:2组的D-二聚体水平在确诊ARDS后第1天即明显升高,但肝素组第3天、第7天、第14天D-二聚体水平明显低于对照组。2组的PLT水平在确诊ARDS后第1天即开始降低,第3~7天跌至低谷,但肝素组第3天、第7天、第14天PLT水平明显高于对照组。肝素组病死率为25.8%,明显低于对照组的46.5%。结论:ARDS患者多存在高凝状态和凝血功能异常,PLT降低主要是由于微小血栓形成消耗大量PLT所致。早期使用肝素能够抑制血栓形成,阻断血小板(PLT)消耗,对防治凝血功能异常具有良好效果。
Objective: To investigate the clinical effect of heparin early intervention in preventing and treating coagulopathy in patients with acute respiratory distress syndrome (ARDS). Methods: A total of 162 ARDS patients were randomly divided into two groups: control group (73 cases) and heparin group (89 cases). The control group was given routine treatment (including maintenance of organ function, surgical intervention, mechanical ventilation, anti-infection, nutrition support, etc.). Heparin group given routine treatment heparin, heparin daily dose of 6 250 ~ 18 750U, the prothrombin time (PT) and activated partial thromboplastin time (APTT) control in the normal 2 to 3 times, and according to PT and APTT Review the results of the adjustment of the amount of heparin, continuous 7 ~ 14d. After the transfer into the ICU, the first day, the third day, the seventh day, the fourteenth day to check PLT, D-dimer; Results: The level of D-dimer in the two groups increased significantly on the first day after ARDS was confirmed. However, the D-dimer level on the 3rd, 7th and 14th day in the heparin group was significantly lower than that of the control group. The PLT levels of the two groups began to decrease on the first day after the diagnosis of ARDS and dropped to the trough on the 3rd to 7th day. However, the PLT levels of the 3rd, 7th and 14th days of the heparin group were significantly higher than those of the control group. Heparin group mortality was 25.8%, significantly lower than 46.5% of the control group. Conclusion: There are many hypercoagulable states and coagulation abnormalities in patients with ARDS. The decrease of PLT is mainly caused by a large amount of PLT caused by micro thrombosis. Early use of heparin can inhibit thrombosis, blocking platelet (PLT) consumption, prevention and treatment of coagulation disorders with good results.