低分子肝素钠辅助治疗D二聚体升高的老年重症肺炎疗效观察

Efficacy of low molecular weight heparin on severe pneumonia in elderly patients with high level of D-dimer

目的观察低分子肝素在老年重症肺炎患者中的治疗作用及不良反应。方法将2009年1月自2012年12月闸北区中心医院住院的D二聚体(D-D)升高的老年重症肺炎患者随机分为抗凝组和对照组。抗凝组予低分子肝素钠(法安明5000IU/d,皮下注射)治疗;对照组仅给予常规治疗。观察2组治疗前后D-D、静脉血C反应蛋白浓度、动脉血氧分压(PaO2)。比较2组平均住院天数及住院费用,观察2组病死率及不良反应。结果抗凝组治疗后D-D较对照组显著降低(P<0.01),为(0.66±0.38)mg/L和(1.19±0.55)mg/L。抗凝组治疗后PaO2显著高于对照组(P<0.05),为(77.4±12.9)mmHg和(62.8±12.3)mmHg。且抗凝组平均住院天数减少,平均住院费用更低。治疗组病死率为9.09%,观察组病死率为20.45%,2组差异无统计学意义。2组不良反应均少见且轻微。结论低分子肝素钠辅助治疗老年重症肺炎可明显改善患者缺氧,减少住院天数及住院费用,不良反应少,是治疗老年重症肺炎有效的治疗方法。

Objective To evaluate the clinical effect and safety of low molecular weight heparin in the treatment of severe pneumonia in elderly patients with high D-dimer. Methods Eighty-nine cases of severe pneumonia with high level of D-dimer were randomly divided into two groups. The experiment group was given subcutaneous injection of low molecular weight heparin 5000 IU/d for 5 to 7 days. The control group was given conventional therapy. Artery Blood oxygen pressure(PaO2) in arterial blood and C-reactive protein concentration(CRP),D-dimer before and after treatment were measured. The fatality rate and adverse drug reactions were observed. Results After anticoagulant therapy, PaO2 in the experimental group had a more significant improvement than that in the control group[(77.4±12.9)mmHg vs (62.8±12.3) mmHg,P<0.05]. The level of D-dimer in the experiment group had a more significant decrease than that in the control group[(0.66±0.38) mg/L vs (1.19±0.55) mg/L,P<0.01].The experiment group had shorter hospital stay(days) and lower cost of hospitalization than the control group. There was no statistical difference in the fatality rate between two groups (9.09 % vs 20.45%,P>0.05).The adverse drug reactions were few and mild in both groups. Conclusions Low molecular weight heparin is effective and safe to severe pneumonia in elderly patients.