低分子肝素对老年重症肺炎患者呼吸相关参数的影响

目的探讨低分子肝素对老年重症肺炎在常规治疗基础上加用低分子肝素对患者氧合指数（氧分压，吸人氧浓度）及机械通气时间的影响。方法选择2009年10月-2013年11月住重症监护病房（ICU）的老年重症肺炎患者，采用随机数字表分为两组，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4000U皮下注射，每日1次，治疗7d。分别于治疗后第1d、第3d、第7d时比较两组患者氧合指数，呼吸末正压（PEEP）及两组患者总的机械通气时间。结果两组患者入组时基本资料及APACHE1I评分无差异。对照组治疗后第1d、第3d、第7d分别有1、2、2例出血（累计），治疗组分别有0、2、3例（累计）。对照组和治疗组在治疗第1d和第3d的氧合指数之间比较差异无统计学意义（208．7±86．82与228．05±83．6，232．57±114．39与245．8±73．25，P均〉0．05）。第7d时，治疗组氧合指数明显高于对照组（289．43±148．41与247．42±86．55，P〈0．05），呼吸末正压明显低于对照组（5．52±0．26与6．21±0．57，P〈0．05）。治疗组患者机械通气时间（h）略短于对照组（152．45±114．45比195．17±118．57，P〉0．05）。结论老年重症肺炎患者在接受常规治疗基础上加用低分子肝素，能改善患者氧合，降低呼吸末正压，缩短机械通气时间，出血副作用未增加，对改善患者预后有益。

Effect of low molecular heparin on prognosis of severe pneumonia in senile patients

Objective To investigate the effect of low molecular heparin on oxygenation index and the duration of mechanical ventilation in senile patients with severe pneumonia. Method The 81 senile patients with severe pneumonia aged above 65 from October 2009 to November 2013 were randomly divide into treatment group and control group. Based on the normal treatment, low molecular heparin （4 000U） once a day was subcutaneously injected for 7days in treatment group, meanwhile normal treatment in the control group. Oxygenation index, positive end-expiratory pressure（PEEP） and duration time of mechanical ventilation were compared on the 1st day, 3rd day and 7th day after treatment. Results There was no difference in the basic data and APACHE II score between two groups before treatment. After treatment, accumulative total 1, 2 and 2 hemorrhage cases were found on 1st , 3rd and 7th day in the control group, however, there were accumulative total 0, 2 and 3 cases in the treatment group on 1st and 3rd day .There was no difference in oxygenation index（208.7±86.82 VS 228.05±83.6, 232.57± 114.39 VS 245.8 ±73.25, P〉 0.05）between two groups .But oxygenation index of the treatment group on 7th day was significantly higher than the control group （289.43± 148.41 VS 247.42±86.55, P〈 0.05）.The positive end-expiratory pressure （PEEP） was lower than the control group （5.52±0.26 VS 6.21 ±0.57, P〈 0.05）. There was no statistic difference in the duration of mechanical ventilation between two groups（152.45±114.45 VS 195.17±118.57 P〉 0.05）.Conclusion In senile patients with severe pneumonia, low molecular heparin as auxiliary therapy may improve patient oxygenation, reduce the positive end-expiratory pressure, decrease the duration of mechanical ventilation and have less side effect of hemorrhage, and improve the prognosis.