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低分子肝素在新冠病毒肺炎导致ARDS中的抗凝治疗研究进展
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Abstract:
急性呼吸窘迫综合征(ARDS)是新冠病毒肺炎(COVID-19)较为常见的致命性并发症，而凝血/纤溶系统功能的紊乱是COVID-19患者的一个重要特征，常提示其预后不良，抗凝治疗可能是新冠病毒肺炎导致ARDS患者治疗的一个新靶点。低分子肝素(LMWH)具有抗凝、抗炎、抗氧化等多重药理作用，但应用低分子肝素进行抗凝治疗的相关临床研究均局限于小样本、单中心，尚缺乏大规模、多中心的临床研究，且研究结局不甚统一，尚无准确的结论，因此低分子肝素对新冠肺炎所致ARDS的抗凝治疗作用有待进一步研究。本文从新冠病毒肺炎致ARDS的病理生理学机制及临床特点等方面入手，探寻低分子肝素对该类患者的抗凝治疗策略及存在的问题。
Acute respiratory distress syndrome (ARDS) is a relatively common fatal complication of coronavirus pneumonia (COVID-19), and dysfunction of coagulation/fibrinolysis system is an important feature of COVID-19 patients, which often indicates poor prognosis. Anticoagulation therapy may be a new target for the treatment of ARDS patients caused by COVID-19. Low molecular weight heparin (LMWH) has multiple pharmacological effects such as anticoagulation, anti-inflammatory, antioxidant, etc. However, clinical studies related to the application of LMWH in anticoagulation therapy are limited to small samples and single centers, and there is still a lack of large-scale and multi-center clinical studies with inconsistent outcomes and no accurate conclusions. Therefore, the anticoagulant effect of low molecular weight heparin on ARDS induced by COVID-19 needs further study. In this paper, the pathophysiological mechanism and clinical characteristics of ARDS caused by novel coronavirus pneumonia were discussed to explore the anticoagulant treatment strategy and existing problems of low molecular weight heparin in these patients.
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