早期营养支持联合谷氨酰胺和低分子肝素对老年重症肺炎患者的疗效研究

目的：探讨早期营养支持联合谷氨酰胺和低分子肝素对老年重症肺炎患者的疗效，以及对免疫功能调节和晚期糖基化终末产物受体（RAGE）的影响。方法选取2012年10月至2015年5月该院重症医学科收治的老年重症肺炎患者148例，按照随机数字表法分为治疗1组（55例）、治疗2组（55例）和对照组（38例）；对照组给予常规治疗，治疗1组在对照组基础上给予早期肠内营养制剂能全力支持疗法和谷氨酰胺治疗；治疗2组在治疗1组基础上采取低分子肝素。比较3组患者治疗前后的急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）、二氧化碳分压（PaCO2）、血氧饱和度（SaO2）和血氧分压（PaO2）；检测3组血浆凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（FIB）和D‐二聚体（D‐D）；比较3组患者免疫功能指标和晚期糖基化终末产物受体（RAGE）水平。结果治疗后，两治疗组患者 APACHEⅡ评分、PaCO2及RAGE水平均低于对照组，SaO2、PaO2及免疫功能指标水平均高于对照组，且治疗2组APACHEⅡ评分、PaCO2及 RAGE水平均低于治疗1组，SaO2、PaO2及免疫功能指标水平均高于治疗1组，差异均有统计学意义（P＜0．01）。治疗2组治疗后PT、APTT、FIB和D‐D均低于治疗1组和对照组（ P＜0．01）。治疗1组和治疗2组的治疗总有效率分别为96．36％和98．18％，均优于对照组，且治疗2组的显效率（85．45％）优于对照组和治疗1组，差异均有统计学意义（ P＜0．01或 P＜0．05）。结论早期营养支持联合谷氨酰胺和低分子肝素治疗老年重症肺炎能够降低患者APACHEⅡ评分，改善凝血功能，增强免疫功能和降低RAGE水平。

Efficacy of early nutrition support combined with glutamine and low molecular heparin in elderly patients with severe pneumonia

Objective To investigate the efficacy of early nutrition support combined with glutamine and low molecular hepa‐rin in elderly patients with severe pneumonia and its influence on immune function regulation and RAGE .Methods Totally 148 eld‐erly patients with severe pneumonia in ICU of our hospital from October 2012 to May 2015 were selected and randomly divided into the treatment group 1 (55 cases) ,treatment group 2 (55 cases) and control group(38 cases) according to the randomized digital ta‐ble .The control group was given the routine treatment .Based on the control group ,the treatment group 1 was treated with the early nutrition support combined with glutamine .On the basis of the treatment group 1 ,the treatment group 2 adopted low molecular heparin .The APACHEⅡ score ,PaCO2 ,SaO2 ,and PaO2 before and after treatment were compared among three groups .The levels of PT ,APTT ,FIB and D‐D were detected in three groups .The immune function indexes and RAGE level were compared among three groups .Results The APACHEⅡ score ,PaCO2 and RAGE level after treatment in two treatment groups were lower than those in the control group ,while SaO2 ,PaO2 and immune function indexes levels were higher than those in the control group ,more‐over the APACHEⅡscore ,PaCO2 and RAGE level in the treatment group 2 were lower than those in the treatment group 1 ,while SaO2 ,PaO2 and immune function level were higher than those in the treatment group 1 ,the differences were statistically significant (P<0 .01) .The levels of PT ,APTT ,FIB and D‐D after treatment in the treatment group 2 were lower than those in the treatment group 1 and control group(P<0 .01) .The total effective rates in the treatment group 1 and 2 were 96 .36% and 98 .18% respec‐tively ,which were higher than that in the control group ,moreover the obviously effective rate in the treatment group 2 was 85 . 45% ,which was superior to the control group and treatment group1 ,the differences were statistically significant (P<0 .01 or P<0 . 05) .Conclusion Early nutrition support combined with glutamine and low molecular heparin in treating elderly severe pneumonia can decrease the APACHEⅡscore ,improve the coagulation function ,enhance the immune function and decreases the RAGE level .