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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 investigate whether the addition of low molecular weight heparin can improve APACHEⅡscore and arterial blood gas analysis parameters based on the routine treatment of elderly patients with severe pneumonia. Methods Aged patients with severe pneumonia admitted to a hospital from October 2009 to September 2011 were randomly divided into treatment group (n = 23) and control group (n = 20). The control group was given routine treatment. The treatment group was given subcutaneous injection of low molecular weight heparin 4 000 U once a day for 7 days on the basis of routine treatment. The differences of APACHEⅡscore, arterial blood pH, PaO2, PaCO2 and Lac between the two groups were compared at 24 h, 3 d and 7 d after treatment. Results There was no significant difference in basic data and APACHEⅡscore between the two groups (P> 0.05). There was no significant difference in the incidence of bleeding during the treatment (P> 0.05). There was no significant difference in APACHEⅡscore between the two groups on the 24th and the 3rd day of treatment (P> 0.05), but on the 7th day of treatment, APACHEⅡscore of the treatment group (13.71 ± 3.65) was lower than that of the control group (16.95 ± 4.70), the difference was statistically significant (t = 2.47, P = 0.02). There was no significant difference in mean arterial blood pH, PaCO2 and Lac between the two groups on the 24th, the 3rd and the 7th day of treatment (P> 0.05). On the 24th and the 3rd day of treatment, PaO2 in the arterial blood of patients in the treatment group was significantly higher than that in the control group (88.6 ± 22.2) (P> 0.05), but the difference was statistically significant (P> 0.05) t = -2.15, P = 0.04). Conclusions The elderly patients with severe pneumonia combined with low molecular weight heparin on the basis of routine treatment can improve oxygenation and reduce APACHEⅡscore in patients.