Elsharnouby Noha M, Eid Hala E A, Abou Elezz Nahla F, Aboelatta Yasser A
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain-shams University, Cairo, Egypt.
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Ain-shams University, Cairo, Egypt.
J Crit Care. 2014 Feb;29(1):182.e1-4. doi: 10.1016/j.jcrc.2013.06.017. Epub 2013 Aug 8.
Nebulized heparin may reduce fibrin cast formation and reduce the degree of airway obstruction in burn inhalation injury.
Twenty-nine patients admitted to burn intensive care unit (ICU) within 24 hours of burn inhalation injury were included in this prospective double-blinded randomized study. Group H5 received nebulized heparin sulfate 5,000 IU, and group H10 received nebulized heparin sulfate 10,000 IU. Heparin was given in alternation with N-acetylcysteine every 2 hours. Lung injury score assessed daily for 7 days was the primary outcome. Duration of mechanical ventilation, coagulation profile, length of ICU stay, and mortality were the secondary outcomes.
Median lung injury scores were significantly lower in group H10 on days 5 (1.9 vs 1), 6 (1.4 vs 0.5), and 7 (1.3 vs 0.5). Group H10 had also a lower duration of mechanical ventilation than did group H5 (P = .037). The groups had no significant difference in coagulation parameters, length of ICU stay (P = .17), and mortality (P = .6).
Nebulized heparin 10,000 IU decreased lung injury scores and duration of mechanical ventilation but had no effect on length of ICU stay and mortality. Moreover, nebulized heparin 10,000 IU was safe and had no effect on coagulation parameters.
雾化吸入肝素可能会减少烧伤吸入性损伤中纤维蛋白管型的形成，并减轻气道阻塞程度。
本前瞻性双盲随机研究纳入了29例在烧伤吸入性损伤后24小时内入住烧伤重症监护病房（ICU）的患者。H5组接受5000 IU硫酸肝素雾化吸入，H10组接受10000 IU硫酸肝素雾化吸入。肝素与N-乙酰半胱氨酸每2小时交替使用。主要结局指标为连续7天每日评估的肺损伤评分。次要结局指标为机械通气时间、凝血指标、ICU住院时间和死亡率。
H10组在第5天（1.9比1）、第6天（1.4比0.5）和第7天（1.3比0.5）的肺损伤评分中位数显著更低。H10组的机械通气时间也比H5组短（P = 0.037）。两组在凝血参数、ICU住院时间（P = 0.17）和死亡率（P = 0.6）方面无显著差异。
10000 IU雾化吸入肝素可降低肺损伤评分和机械通气时间，但对ICU住院时间和死亡率无影响。此外，10000 IU雾化吸入肝素是安全的，对凝血参数无影响。
