小剂量肝素联合治疗重症肺炎的观察研究  

Observation and research of small dose of heparin in combined treatment of severe pneumonia

作　　者：林玫瑞[1] 陈晓红[1] 林琛[2] 

机构地区：[1]汕头大学医学院第一附属医院重症医学科,515041 [2]汕头大学医学院第一附属医院核医学科,515041

出　　处：《中国实用医药》2015年第18期16-17,共2页China Practical Medicine

摘　　要：目的探讨联合小剂量肝素治疗重症肺炎的安全性及有效性。方法 32例诊断明确、没有肝素使用禁忌证的重症肺炎患者采用随机对照分组的办法分为治疗组及对照组,各16例。治疗组同时应用200 U/(kg·d)普通肝素分次皮下或静脉给药、连续使用7 d;对照组给予安慰剂处理。监测两组患者治疗前后的急性生理与慢性健康评分(APACHEⅡ评分)、氧合指数、血小板计数、活化部分凝血活酶时间(APTT)、纤维蛋白原(FBG)、白细胞计数(WBC)、C反应蛋白(CRP)等指标;并观察总住院时间、ICU住院时间等。结果治疗1周后治疗组氧合指数较对照组有明显改善,CRP水平则较对照组有明显下降,差异有统计学意义(P均<0.01);APACHⅡ评分较对照组降低,差异有统计学意义(P<0.05)。结论联合小剂量肝素治疗可明显改善重症肺炎患者氧合及降低炎症介质的水平,降低APACHEⅡ评分。Objective To investigate the safety and effectiveness of combined treatment by small dose of heparin for severe pneumonia. Methods A total of 32 diagnosed severe pneumonia patients without contraindication for heparin were randomly divided into treatment group and control group, with 16 cases in each group. The treatment group received 200 U/（kg·d） of heparin by fractional subcutaneous or intravenous administration for 7 d. The control group received placebo. Acute physiology and chronic health evaluation（APACHE Ⅱ score）, oxygenation index, blood platelet count, activated partial thromboplastin time（APTT）, fibrinogen（FBG）, white blood count（WBC）, and C-reactive protein（CRP） of the two groups were monitored before and after treatment. Their total hospital stay and ICU time were observed. Results After 1 week of treatment, the treatment group had more obviously increased oxygenation index and decreased CRP level than the control group. The differences had statistical significance（all P〈0.01）. The treatment group had more decreased APACHE Ⅱ score than the control group, and their difference had statistical significance（P〈0.05）. Conclusion Combined treatment by small dose of heparin for severe pneumonia can obviously improve oxygenation index and reduce inflammatory mediator level and APACHE Ⅱ score of patients.

关 键 词：重症肺炎 肝素 

分 类 号：R563.1[医药卫生—呼吸系统]