低分子肝素治疗对老年重症肺炎患者APACHEⅡ评分及动脉血气分析参数的影响被引量：29

Effect of low molecular weight heparin therapy on the APACHEⅡ score and arterial blood gas analysis parameter in elderly patients with severe pneumonia

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摘要目的探讨在老年重症肺炎患者常规治疗的基础上加用低分子肝素能否改善其APACHEⅡ评分及动脉血气分析参数。方法选择2009年10月—2011年9月入住某院的老年重症肺炎患者,随机分为治疗组(23例)及对照组(20例)。对照组给予常规治疗,治疗组在常规治疗基础上加用低分子肝素4 000 U皮下注射,1次/d,疗程7 d。分别在治疗后24 h、3 d、7 d时比较两组患者APACHEⅡ评分及动脉血pH、氧分压(PaO2)、二氧化碳分压(PaCO2)、乳酸(Lac)是否有差别。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(P>0.05);在治疗过程中的出血发生率差异亦无统计学意义(P>0.05)。在治疗第24小时和第3天,两组患者APACHEⅡ评分均值差异无统计学意义(P>0.05),但在治疗第7天,治疗组APACHEⅡ评分(13.71±3.65)低于对照组(16.95±4.70),差异有统计学意义(t=2.47,P=0.02)。在治疗第24小时、第3天和第7天,两组患者的动脉血pH、PaCO2、Lac均值差异均无统计学意义(P>0.05);在治疗第24小时及第3天,两组患者动脉血PaO2均值差异无统计学意义(P>0.05),但在治疗第7天,治疗组动脉血PaO2(106.8±32.7)明显高于对照组(88.6±22.2),差异有统计学意义(t=-2.15,P=0.04)。结论老年重症肺炎患者在接受常规治疗的基础上加用低分子肝素,能改善患者的氧合,降低APACHEⅡ评分。 Objective To evaluate whether APACHEⅡ score and arterial blood gas （ABG） analysis parameter of elderly patients with severe pneumonia can be improved if low molecular weight heparin （LMWH） was added to conventional therapy. Methods From October 2009 to September 2011, 43 inpatients with severe pneumonia were randomly divided into treatment （n = 23） and control （n= 20） group. Control group received conventional treat- ment, and treatment group received conventional treatment plus the LMWH treatment （4 000U q. d. ） for 7 days. APACHE Ⅱ score, and arterial blood gas analysis （pH of blood, partial pressure of oxygen[PaO2 ], partial pressure of carbon dioxide[PaCO2],lactate[Lac]） were compared at 24 h, day 3 and day 7 of treatment. Results The basic data and APACHEII score in two groups were not significantly different before treatment （P〉0. 05）; the difference in incidence of hemorrhage was not significantly different during treatment （P〉0. 05）; At 24 h and day 3 treatment, APACHE Ⅱ score in two groups was not significantly different （P〈0. 05）, but at day 7, the APACHE Ⅱ score of treatment group was significantly lower than control group （E13. 71 ± 3. 65] vs [16. 95 ± 4. 70%, t - 2. 47, P = 0. 02）. At 24 h, day 3 and day 7, the PH,PaCO2 ,Lac were not significantly different （P〉0. 05） ; at 24 h and day 3, PaO2 was not significantly different （P〉0. 05） ,but at day 7, the PaO2 of treatment group was signifi- cantly higher than control group（[106. 8 ± 32. 7] vs [88. 6 ± 22. 2], t = - 2. 15,P = 0. 04）. Conclusion LMWH plus conventional treatment for elderly patients with severe pneumonia can improve the oxygenation of patients, and re- duce APACHE Ⅱ score.