标题：低分子肝素雾化吸入治疗急性重症胰腺炎合并ALI/ARDS患者的疗效观察

      作者：李雪琳 1，梅立峰 2    汉中市人民医院重症医学科 1、消化内科 2，陕西 汉中 723000

      卷次： 2021年32卷24期

      【摘要】 目的 研究急性重症胰腺炎合并急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者应用低分子肝素雾化吸入治疗的疗效及对患者氧合指数(PaO2/FiO2)、炎症因子水平的影响。方法 选择汉中市人民医院重症医学科2018年2月至2020年2月期间收治的80例急性重症胰腺炎合并ALI/ARDS患者作为研究对象，按照随机数表法将患者分为研究组和对照组各40例。对照组患者采用常规治疗，研究组患者在对照组治疗的基础上雾化吸入低分子肝素治疗，均连续治疗7 d。比较两组患者治疗前后的C反应蛋白(CRP)、白细胞介素-1β (IL-1β)、肿瘤坏死因子-α (TNF-α)水平、氧合指数(PaO2/FiO2)情况；比较两组患者治疗7 d后牙龈出血发生率、皮下瘀斑发生率以及治疗21 d的死亡率。结果 治疗前，两组患者的TNF-α、IL-1β、CRP水平、PaO2/FiO2指标比较差异均无统计学意义(P>0.05)；治疗后，两组患者的TNF-α、IL-1β、CRP水平明显下降，且研究组患者的TNF-α、IL-1β、CRP水平分别为(23.75±2.13) ng/L、(28.46±2.72) ng/L、(82.41±4.38) mg/L，明显低于对照组的(29.46±2.37) ng/L、(35.39±2.23) ng/L、(93.56±4.63) mg/L，PaO2/FiO2明显上升，且研究组患者 PaO2/FiO2为 (342.78±34.76) mmHg，明显高于对照组的(235.69±28.42) mmHg，差异均有统计学意义(P<0.05)；治疗后，研究组患者的牙龈出血发生率、皮下瘀斑发生率和21 d死亡率分别为 5.00%、2.50%、0，明显低于对照组的 22.50%、20.00%、12.50%，差异均有统计学意义(P<0.05)。结论 低分子肝素雾化吸入治疗急性重症胰腺炎并发ALI/ARDS可有效提高患者的氧合指数，降低炎症因子水平，同时有利于降低术后并发症发生率，临床治疗效果显著，具有临床应用价值。
      【关键词】 急性重症胰腺炎；急性肺损伤；急性呼吸窘迫综合征；低分子肝素；疗效
      【中图分类号】 R657.5+1 【文献标识码】 A 【文章编号】 1003—6350（2021）24—3239—03

Effect of low molecular weight heparin atomization inhalation on patients with acute severe pancreatitiscomplicated with acute lung injury/acute respiratory distress syndrome.
LI Xue-lin 1, MEI Li-feng 2. Department ofCritical Medicine 1, Department of Gastroenterology 2, Hanzhong People's Hospital, Hanzhong 723000, Shaanxi, CHINA
【Abstract】 Objective To study the curative effect of low molecular weight heparin atomization inhalation inpatients with severe acute pancreatitis (SAP) complicated with acute lung injury (ALI)/acute respiratory distress syn-drome (ARDS) and its influence on oxygenation index (PaO2/FiO2) and inflammatory factors. Methods Eighty patientswith acute severe pancreatitis complicated with ALI/ARDS treated in the Department of Critical Medicine, HanzhongPeople's Hospital from February 2018 to February 2020 were selected as the research objects. They were randomly divid-ed into the study group and the control group, with 40 patients in each group. The patients in the control group were treat-ed with routine treatment, and the patients in the study group were treated with atomized inhalation of low molecularweight heparin on the basis of the treatment in the control group for 7 days. The levels of C-reactive protein (CRP), inter-leukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and oxygenation index (PaO2/FiO2) in the two groups were com-pared before and after treatment. The incidence of gingival bleeding, the incidence of subcutaneous ecchymosis, and21-day mortality after treatment were compared between the two groups. Results Before treatment, there was no sig-nificant difference in the levels of TNF-α, IL-1β, CRP, and PaO2/FiO2 between the two groups (P>0.05); after treatment,the levels of TNF-α, IL-1β, and CRP in the two groups were significantly decreased, and the levels of TNF-α, IL-1β,and CRP in the study group were (23.75±2.13) ng/L, (28.46±2.72) ng/L, (82.41±4.38) mg/L, which were significantly·短篇论著·doi:10.3969/j.issn.1003-6350.2021.24.031