低分子肝素对老年重症肺炎患者预后的影响  

The effect of low molecular heparin on the prognosis of severe pneumonia in elderly patients

作　　者：王平[1] 王玺[1] 张丽涓[1] 杨芳[1] 王国祥[1] 李雪莲[1] 黄鲜[1] 

机构地区：[1]成都市第五人民医院重症医学科,四川611130

出　　处：《中华危重病急救医学》2013年第12期734-737,共4页Chinese Critical Care Medicine

基　　金：四川省医药卫生科研项目（100043）;四川省成都市医药卫生青年基金科研课题（0908）

摘　　要：目的探讨低分子肝素对老年重症肺炎患者病情严重程度及预后的影响。方法采用前瞻性随机对照研究方法，选择2009年10月至2013年7月住重症监护病房（ICU）63例年龄≥65岁的重症肺炎患者，按随机数字表法分为两组。对照组36例给予常规治疗；治疗组39例在常规治疗基础上加用低分子肝素4ku皮下注射，每日1次，治疗7d。分别于治疗后1、3、7d时比较两组患者急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、凝血指标、动脉血气分析指标、动脉血乳酸（Lac），以及机械通气时间、住ICU时间和7d病死率。结果两组患者入组时基本资料及APACHEⅡ评分差异无统计学意义（均P〉0．05）。对照组治疗后1、3、7d分别有1、1、2例出血；治疗组分别有0、1、3例出血。对照组和治疗组治疗后1d、3d的APACHEⅡ评分比较差异均无统计学意义（1d（分）：19．33±5．90比20．31±4．97，t=0．775，P=0．441；3d（分）：18．69±4．88比17．41±3．83，t=1．272，P=0．207]，7d时治疗组APACHEⅡ评分明显低于对照组（分：13．92±3．61比16．20±4．23，t=2．480，P=0．016）。两组患者在观察期间各凝血指标均无差异（均P〉0．05）。动脉血气分析结果显示，治疗组仅治疗后7d动脉血氧分压（PaO2）明显高于对照组（mmHg（1mmHg=0．133kPa）：110．52±28．57比95．47±24．17，t=-2．354，P=0．022]。两组患者治疗后7d病死率差异无统计学意义。治疗组患者机械通气时间略短于对照组（h：147．45±111．45比192．20±115．57，t=1．704，P=0．093），住ICU时间显著短于对照组（d：13．77±5．77比17．22±6．21，t=2．497，P=0．015）。结论老年重症肺炎患者在接受常规治疗基础上加用低分子肝素，能降低APACHEⅡ评分，缩短机械通气时间及住ICU时间，改善患者预后。Objective To investigate the effect of low molecular heparin on degree of severity and prognosis of severe pneumonia in elderly patients. Methods A prospective randomized control study was conducted. During October 2009 to July 2013, 63 patients over 65 years old and suffering from severe pneumonia were enrolled. Patients were grouped into control or treatment group randomly. The control group （n = 36） received routine treatment, while low molecular heparin 4 kU once a day was added in treatment group （n=39） for 7 days. Acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score, coagulation function indexes, blood gas analysis, arterial lactic acid at 1, 3, 7 days after treatment, and length of mechanical ventilation, days of stay in ICU, and 7-day mortality were compared between both groups. Results The basic data and APACHE Ⅱ score had no difference between two groups （all P〉 0.05）. Bleeding events occurred on day 1, 3, 7 in 1, 1, 2 patients in control group, respectively, and 0, 1, 3 cases in treatment group. There was no difference in APACHE Ⅱ score on day 1 and day 3 between control group and treatment group （1 day： 19.33 ±5.90vs. 20.31 ±4.97, t=0.775, P=0.441; 3 days： 18.69±4.88vs. 17.41±3.83, t=1.272, P=0.207 ）. APACHE Ⅱ score on day 7 in treatment group was significantly lower than that in control group （13.92 ± 3.61 vs. 16.20 ± 4.23, t=2.480, P=0.016）. There was no significant difference in coagulation function indexes during observation period between two groups （all P〉0.05 ）. The blood gas analysis showed that only arterial partial pressure of oxygen （PaO2） 7 days after treatment in treatment group was significantly higher than that in control group [ mm Hg （ 1 mm Hg=0.133 kPa） ： 110.52 ± 28.57 vs. 95.47 ± 24.17, t=2.354, P=0.022]. There was no significant difference in 7-day mortality between two groups. The mechanical ventilation time in treatment group was slightly shorter than that in control group （hours： 147.45 ± 111.45

关 键 词：重症肺炎 低分子肝素 急性生理学与慢性健康状况评分系统Ⅱ评分 机械通气时间 

分 类 号：R563.1[医药卫生—呼吸系统]