摘要
摘要目的探讨在常规治疗的基础上加用低分子肝素钙抗凝治疗对老年重症肺炎患者治疗效果的影响.方法将８２例老年重症肺炎患者随机分为治疗组和对照组各４１例,对照组采用改善通气、抗感染、平喘、化痰、纠正水和电解质紊乱等常规治疗.治疗组在对照组的基础上采用低分子肝素钙６０００IU皮下注射,每日１次.观察两组APACHEⅡ评分、氧合指数、ICU住院时间、呼吸机支持时间和病死率等的差异.结果治疗前两组APACHEⅡ评分无统计学差异,治疗后３d、７d两组APACHEⅡ评分均下降,且和前一时间点比有统计学差异(p＜０．０５);治疗后３d、７d治疗组APACHEⅡ评分均低于对照组,且差异有统计学意义(p＜０．０５).氧合指数两组治疗前差异无统计学意义(p＞０．０５);治疗后３d、７d均有不同程度升高,和前一时间段比差异有统计学意义(p＜０．０５);治疗后３d,治疗组氧合指数高于对照组,但差异无统计学意义(p＞０．０５);治疗后７d,治疗组氧合指数高于对照组,差异有统计学意义(p＜０．０５).PaCO２,治疗前两组无统计学差异(p＞０．０５),治疗后两组均有不同程度的降低和前一时间段比差异有统计学意义(p＜０．０５);治疗后３d,治疗组PaCO２低于对照组,但差异无统计学意义(p＞０．０５);治疗后７d,治疗组PaCO２低于对照组,差异有统计学意义(p＞０．０５).治疗组ICU住院时间、呼吸机支持时间和病死率均低于对照组,且有统计学差异(p＜０．０５).结论对老年重症肺炎患者,在常规治疗的基础上,加用低分子肝素钙进行抗凝治疗,可缩短呼吸机支持时间和ICU住院时间,增加氧合指数,减少病死率,具有较高的临床价值.关键词重症肺炎;抗凝治疗;低分子肝素钙;预后ThePrognosticanalysisofanticoagulanttherapyonthetheelderlypatientsseverepneumoniaAbstractObjectiveToanalyzethetreatmenteffectoftheroutinetreatmentcombiningwithlowmolecularweightheparinontheelderlypatientsseverepneumonia．Methods８２casesofelderlypatientswithseverepneumoniawererandomlydividedintotreatmentgroup(n＝４１cases)andcontrolgroup(n＝４１caＧses)．Thepatientsofcontrolpatientsweretreatedwithconventionaltreatmentsofimprovingventilation,anti－infection,antiasthmatic,eliminatingphlegmandcorrectingwater－electrolyteimbalance．Thepatientsoftreatmentgroupweretreatmentwithlowmolecularweightheparin６０００IUbyhypodermicinjectionbasedonconventionaltreatments,２timeseachday．APACHEⅡscores,oxygenationindex,ICUstaytime,respiratorsupporttimeandmortalityratewereobserved．ResultsTherewasnotsignificantlydifferentintheAPACHEⅡscoresbetweentwogroupsbeforetreatment,whileAPACHEⅡscoresweredecreased３days,７daysaftertreatmentintwogroupswithsignificantlydifferent(p＜０．０５)comparedwiththoseinpreviuostime．APACHEⅡscoresofpatientsintreatmentgroupswerelowerthancontrolgroupwithsignificantlydifferent(p＜０．０５)３daysand７daysaftertreatment．TheoxygenationindexswerenotsignificantlydifＧf(erentbetweentwogroupsbeforetreatmentandtheoxygenationindexsoftwogroupswereincreased３daysand７daysaftertreatmentwithsignificantlydifferentp＜０．０５)comparedwiththoseinpreviuostime．Theoxygenationindexsofpatientsintreatmentwerehigherthancontrolgroupbuttherewasnotsignificantlydifferentbetweentwogroups３daysaftertreatment．Theoxygenationindexsofpatientsintreatmentwerehigherthancontrolgroupwithsignificantlydifferent(p＜０．０５)７daysaftertreatment．TherewasnotsignificantlydifferentinthePaCO２betweentwogroupsbeforetreatment(p＞０．０５),whilethePaCO２ofpatientsintwogroupsweredecreasedwithsignificantlydifferent(p＜０．０５)comparedwiththoseinpreviuostime．ThePaCO２ofpatientsintreatmentgroupwerelowerthancontrolgroupwithnotsignificantlydifferent(p＞０．０５)３daysaftertreatment．ThePaCO２ofpatientsintreatmentgroupwerelowerthancontrolgroupwithsignifＧicantlydifferent(p＜０．０５)７daysaftertreatment．TheICUstaytime,respiratorsupporttimeandmortalityrateoftreatmentgroupwerelowerthancontrolgroupwithsignificantlydifferent(p＜０．０５)．ConclusionThelowmolecularweightheparincombinedwithconventionaltreatmentforelderlypatientswithseverepneuＧmoniaKceaynwshorodrtsenrespiratorsupporttimeandICUstaytime,improveoxygenationindexs,decreasemortalityrate,whichhaveveryimportantclinicvalue．Severepneumonia;Anticoagulanttherapy;Lowmolecularweightheparin;Outcome中图分类号R５９２文献标识码B文章编号１００８－６３１５(２０１５)１０－００２１－０２
出版日期
2015年09月19日（中国期刊网平台首次上网日期，不代表论文的发表时间）
