CAJ | 학술논문

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7 d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)中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组氧合指数（OI）明显升高，P＜0.01，BALF中的IL-6、APACHEⅡ评分下降显著。其中，肝素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，P＜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，肝素肺泡灌洗组和肝素雾化组死亡率低于对照组，P＜0.05。结论肝素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。
목적：탐토간소납(UFH)폐관세치료급성폐손상적림상료효급가능적작용궤제。방법선택120례급성폐손상/급성호흡군박종합정（ALI/ARDS）적환자，수궤분위대조조、간소폐포관세조화간소무화조。대조조：사용상규치료기출상행생리염수폐관세；간소폐포관세조：상규치료기출상행간소납염수폐관세；간소무화조：재상규치료기출상행기도무화흡입간소납。관찰화비교3조환자치료7 d후양합지수、급성생이학여만성건강상황Ⅱ（APACHEⅡ）평분、폐포관세액(BALF)중IL-6이급PLT、APTT변화、7d사망솔。결과각조치료7d 후각항지표교전유호전，간소폐포관세조화간소무화조교대조조양합지수（OI）명현승고，P＜0.01，BALF중적IL-6、APACHEⅡ평분하강현저。기중，간소폐포관세조양합지수우우간소무화조，이IL-6、APACHEⅡ평분교무화조저，P＜0.05。간소폐포관세화간소무화치료후PLT、APTT여대조조비교무차이。간소폐포관세조、간소무화조、대조조사망솔분별위7.5％，12.5％，26.8％，차이유통계학의의，간소폐포관세조화간소무화조사망솔저우대조조，P＜0.05。결론간소폐관세화간소무화흡입치료ALI/ARDS，능구개선양합；억제IL-6등염증개질적석방，강저염증반응，종이강저환자적사망솔。
Objective To investigate the effect and possible mechanism bronchial alveolar lavage with unfractioned heparin in ALI/ARDS patients. Methods A total of 120 ALI/ARDS patients were randomly divided into control group, BAL group, and atomizationg group. Patients in the control group were treated with routine therapy, while patients in BAL group and atomization group respectively received unfractionated heparin bronchial alveolar lavage and ultrasonic atomizing inhalation of unfractionated heparin on top of the routine therapy. The three groups with 7 days of oxygen index, APACHEⅡ scores, IL-6 level of BALF, and PLT, APTT change, and 7 days mortality were observed and compared. Results The 7-day indexes reflected a better result in all three groups, and anticoagulation group (BAL group and atomization group) was better than control group. The oxygen of BAL group was better than that of atomization group, while BALF IL-6 level and APACHEⅡscores of BAL group were lower than those of atomization group. PLT and APTT of the three groups had no significant difference before and after the treatments was offered. Mortality rates of BAL group, atomizationg group, and control group were 7.5%, 12.5%, and 26.8%, respectively. Difference was found among the three groups. Anticoagulation group was better than control group. Conclusion It was proved that UFH bronchial alveolar lavage resulted in activating fibrinolysis system and improving ventilate function, lowering local coagulability, and inhibiting the release of IL-6, reducing the systemic inflammation, which is considered being effective eventually reducing mortality of the patients.