两种肝素类药物辅助应用对老年重症社区获得性肺炎病人疗效及安全性的影响

目的探讨普通肝素和低分子肝素辅助应用对老年重症社区获得性肺炎(CAP)病人血气分析指标、急性生理与慢性健康评分(APACHE-Ⅱ)及凝血功能的影响.方法选取我院2015年1月至2017年10月收治的老年重症CAP病人140例,按随机数字表法分为A组(70例)和B组(70例).在常规对症干预基础上,A组给予普通肝素,B组给予低分子肝素.比较2组病人的临床疗效、有创通气率、死亡率、治疗前后血气分析指标、APACHE-Ⅱ评分、凝血功能水平及出血事件发生率.结果2组病人临床疗效和死亡率比较差异无统计学意义(P>0.05).治疗后,B组有创通气率显著低于A组(P<0.05);动脉血氧分压(PaO2)、动脉二氧化碳分压(PaCO2)及血氧饱和度(SpO2)水平均优于A组及治疗前(P<0.05);APACHE-Ⅱ评分显著低于A组及治疗前(P<0.05).治疗后,B组活化部分凝血活酶时间(APTT)和凝血酶原时间(PT)水平显著低于A组(P<0.05),但与治疗前相比差异无统计学意义(P>0.05).2组治疗前后血小板水平比较差异均无统计学意义(P>0.05).治疗后,2组血栓素B2(TXB2)和6-酮前列腺素F1α(6-keto-PGF1α)水平比较差异无统计学意义(P>0.05),但与治疗前相比差异均有统计学意义(P<0.05).治疗后,B组P选择素(CD62p)水平显著低于A组及治疗前(P<0.05).2组病人出血事件发生率比较差异无统计学意义(P>0.05).结论低分子肝素辅助治疗老年重症CAP病人可显著降低有创通气率,改善血气分析指标,控制病情进展,调节凝血功能,且未发生严重出血不良事件,价值优于普通肝素.

Influence of two kinds of heparin on clinical effects and safety of elderly patients with severe community acquired pneumonia

Objective To investigate the influence of unfractionated heparin and low molecular weight heparin on blood gas analysis index,Acute Physiology and Chronic Health Evaluation(APACHE-Ⅱ) score and blood coagulation function in the elderly patients with severe community acquired pneumonia(CAP).Methods A total of 140 elderly patients with severe CAP were selected from January 2015 to January 2016 in our hospital,and they were divided into group A(n=70) and group B(n=70) randomly.On the basis of systematic intervention,group A was given unfractionated heparin,and group B was given low molecular weight heparin.Clinical effect,invasive ventilation rate,mortality,the levels of blood gas analysis indexes,APACHE-Ⅱ score,coagulation function before and after treatment and the incidence rate of bleeding events were compared between the two groups.Results There were no significant differences in the clinical effect and mortality between the two groups(P>0.05).After treatment,the invasive ventilation rate in group B was significantly lower than that in group A(P<0.05),and the levels of PaO2,PaCO2 and SpO2 in group B were significantly better than those in group A and before treatment(P<0.05),and the APACHE-Ⅱ score in group B was significantly lower than that in group A and before treatment(P<0.05).After treatment,the levels of activated partial thromboplastin time(APTT) and prothrombin time(PT) in group B were significantly lower than those in group A(P<0.05),but there was no significant difference compared with those before treatment(P>0.05).There was no significant difference in platelet level between the two groups before and after treatment(P>0.05).There were no significant differences in the levels of TXB2 and 6-keto-PGF1α between the two groups after treatment(P>0.05),but the differences were significant compared with those before treatment(P<0.05).After treatment,the level of P-selectin(CD62 p) in group B was significantly lower than that in group A and before treatment(P<0.05).There was no significant difference in the incidence rate of bleeding events between the two groups(P>0.05).Conclusions Low molecular weight heparin can efficiently reduce invasive ventilation rate,improve blood gas analysis index,control disease progress,regulate blood coagulation function in the elderly patients with severe CAP,and no serious bleeding adverse events occur.Its value is superior to that of unfractionated heparin.