低分子肝素对老年重症肺炎患者预后的影响

The effect of low molecular heparin on the severe pneumonia in elderly patients

目的探讨低分子肝素(LMWH)辅助治疗老年重症肺炎的疗效情况。方法选取2010年1月至2017年1月入住该院呼吸重症监护病房(RICU)的老年重症肺炎患者59例(重症肺炎组),分为LMWH组20例、普通肝素(UFH)组20例、对照组19例,并选择同期入住呼吸科的老年非重症肺炎患者60例作为非重症肺炎组,分别在治疗前及治疗3、7、14d进行急性生理和慢性健康评分(APACHEⅡ评分)、血气分析、凝血功能检查,比较各两组之间差异。结果重症肺炎组患者凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)水平明显高于非重症肺炎组患者,差异均有统计学意义(均P<0.05)。治疗前、治疗后3d,重症肺炎3组患者APACHEⅡ评分比较,差异均无统计学意义(P>0.05)。治疗后7、14d,LMWH组APACHEⅡ评分明显低于对照组(t=2.599、8.595,P<0.05)和UFH组(t=3.04、-4.40,P<0.05)。治疗前及治疗后3、7d,重症肺炎3组患者PT、APTT、TT、FIB水平比较,差异均无统计学意义(P>0.05)。治疗前、治疗后3d重症肺炎3组患者D-D水平比较,差异无统计学意义(P>0.05);治疗后7、14d,LMWH组D-D水平明显低于对照组(t=2.981、6.344,P<0.05)、UFH组(t=-2.272、-6.003,P<0.05)。治疗前及治疗后3、7d时重症肺炎3组患者动脉血pH值、动脉血二氧化碳分压(PaCO_2)均无明显差异。治疗前及治疗后3d重症肺炎3组患者动脉血氧分压(PaO_2)差异无统计学意义(P>0.05),LMWH组PaO_2明显高于对照组(t=-6.135、-5.816,P<0.05)、UFH组(t=4.686、6.399,P<0.05);治疗3、7d,血乳酸(Lac)均无明显差异,治疗14d后,LMWH组Lac明显低于对照组(t=5.675,P<0.05)、UFH组(t=-6.007,P<0.05)。结论老年重症肺炎患者存在凝血功能异常,使用LMWH能降低老年重症肺炎患者的APACHEⅡ评分,提高患者的氧合,进而改善预后,且效果优于UFH。

Objective To investigate the effect of low molecular heparin on severe pneumonia in elderly patients. Methods A total of 59 cases of elderly patients with severe pneumonia in Jiangyin people′s hospital from January 2010 to January 2017 were selected,who divided into three groups randomly.The control group （19 cases） was given conventional treatment,the LMWH group （20 cases） was treated with low molecular heparin 4 250 U subcutaneous injection,the UFH group （20 cases） was treated with un-fractionated heparin 6 250 U subcutaneous injection.After treatment 3 d,7 d,14 d,the bleeding rate,blood coagulation indexes and APACHEⅡ score were compared. Results Compared with the pneumonia in elderly patients,the severe pneumonia in elderly patients′ level of PT,APTT,TT,FIB,D-dimer and PLT significantly higher.The APACHEⅡ score on day 7 and day 14 of LMWH group was significantly lower than control group and UFH group,but,the score on day 0 and 3 had no significant difference.The lever of PT,APTT,TT,FIB after treatment 0 d,3 d,7 d,14 d had no significant difference （ P 〉0.05）;the lever of D-dimer after treatment 0 d,3 d had no significant difference （ P 〉0.05）,but after treatment 7 d,14 d,the lever significantly lower than control group and UFH group.There there was no significant difference in PaCO 2,pH,after treatment 0 d,3 d,7 d.the PaO 2 of LMWH group was significantly higher than control group and UFH group.the lever of lactic acid on LMWH group was significantly higher than control group and UFH group after treatment 14 d. Conclusion Compared with UFH,LMWH has significant advantages in reducing the APACHEⅡ score in elderly patients with severe pneumonia,improving the oxygenation and prognosis.