小剂量肝素联合治疗重症肺炎的观察研究.pdf

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1、·16·中国实用医药2015年6月第10卷第18期ChinaPracMed，Jun2015，Vo1．10，No．18小剂量肝素联合治疗重症肺炎的观察研究林玫瑞陈晓红林琛【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200U／(kg·d)普通肝素分次皮下或静脉给药、．连续使用7d；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(APACHEI／评分)、氧合指数、血小板计数、活化部分凝血活酶时间(AP1、纤维蛋白原

2、(FBG)、白细胞计数BC)、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(尸均<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APACHE1I评分。【关键词】重症肺炎；肝素DOI：10．14163~．cnki．11-5547／r．2015．18．008Observationandresearchofsmalldoseofheparininco

3、mbinedtreatmentofseverepneumoniaLINMei—rui，CHENXiao-hong,LINChen．DepartmentofIntensiveMedicine，TheFimtAffiliatedHospitalofMedicalCollegeofShantouUniversity,Shantou51500~China【Abstract】objectiveToinvestigatethesafetyandefectivenessofcombinedtreatmentbysmalldoseofheparinforseverepneum

4、onia．MethodsAtotalof32diagnosedseverepneumoniapatientswithoutcontraindicationforheparinwererandomlydividedintotreatmentgroupandcontrolgroup，with16casesineachgroup．Thetreatmentgroupreceived200U／(kg。d)ofheparinbyfractionalsubcutaneousorintravenousadministrationfor7d．Thecontrolgrouprec

5、eivedplacebo．Acutephysiologyandchronichealthevaluation(APACHE1Iscore)，oxygenationindex，bloodplateletcount；activatedpartialthromboplastintime(APTT)，fibrinogen(FBG)，whitebloodcount(WBC)，andC-reactiveprotein(CRP)ofthetwogroupsweremonitoredbeforeandaftertreatment．Theirtotalhospitalstaya

6、ndICUtimewereobserved．ResultsAfter1weekoftreatment，thetreatmentgrouphadmoreobviouslyincreasedoxygenationindexanddecreasedCRPlevelthanthecontrolgroup．Thedifferenceshadstatisticalsignificance(allP<0．01)．ThetreatmentgrouphadmoredecreasedAPACHE1Iscorethanthecontrolgroup．andtheirdifferen

7、cehadstatisticalsignificancefP<0．05)．ConclusionCombinedtreatmentbysmalldoseofheparinforseverepneumoniacanobviouslyimproveoxygenationindexandreduceinflammatorymediatorlevelandAPACHEⅡscoreofpatients．【Keywords】Severepneumonia；Heparin重症肺炎是呼吸系统疾病中常见的由感染导致的危重病年龄、性别等一般资料方面比较，差异无统计学意义(P>O．0

8、5)，症，易出现多种严重并发症，甚至危