Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, AZ, Amsterdam, The Netherlands.
BMC Pulm Med. 2012 Aug 15;12:43. doi: 10.1186/1471-2466-12-43.
Acute lung injury (ALI) is characterized by a pro-coagulant state. Heparin is an anticoagulant with anti-inflammatory properties. Unfractionated heparin has been found to be protective in experimental models of ALI. We hypothesized that an intravenous therapeutic dose of unfractionated heparin would favorably influence outcome of critically ill patients diagnosed with ALI.
Patients admitted to the Intensive Care Unit (ICU) of a tertiary referral center in the Netherlands between November 2004 and October 2007 were screened. Patients who developed ALI (consensus definition) were included. In this cohort, the impact of heparin use on mortality was assessed by logistic regression analysis in a propensity matched case-control design.
Of 5,561 admitted patients, 2,138 patients had a length of stay > 48 hours, of whom 723 were diagnosed with ALI (34%), of whom 164 received intravenous heparin. In a propensity score adjusted logistic regression analysis, heparin use did not influence 28-day mortality (odds ratio 1.23 [confidence interval 95% 0.80-1.89], nor did it affect ICU length of stay.
Administration of therapeutic doses of intravenous unfractionated heparin was not associated with reduced mortality in critically ill patients diagnosed with ALI. Heparin treatment did not increase transfusion requirements. These results may help in the design of prospective trials evaluating the use of heparin as adjunctive treatment for ALI.
急性肺损伤（ALI）的特征是促凝状态。肝素是一种具有抗炎特性的抗凝剂。已发现未分级肝素在 ALI 的实验模型中具有保护作用。我们假设静脉给予治疗剂量的未分级肝素将有利于影响诊断为 ALI 的危重病患者的结局。
筛选 2004 年 11 月至 2007 年 10 月期间在荷兰一家三级转诊中心的重症监护病房（ICU）入院的患者。纳入发生 ALI（共识定义）的患者。在该队列中，通过倾向评分匹配病例对照设计的逻辑回归分析评估肝素使用对死亡率的影响。
在 5561 名入院患者中，2138 名患者的住院时间超过 48 小时，其中 723 名被诊断为 ALI（34%），其中 164 名接受了静脉肝素治疗。在倾向评分调整的逻辑回归分析中，肝素使用并未影响 28 天死亡率（比值比 1.23 [95%置信区间 0.80-1.89]），也未影响 ICU 住院时间。
在诊断为 ALI 的危重病患者中，给予治疗剂量的静脉未分级肝素与降低死亡率无关。肝素治疗并未增加输血需求。这些结果可能有助于设计评估肝素作为 ALI 辅助治疗的前瞻性试验。
