本文選題：老年重癥肺炎　切入點(diǎn)：低分子肝素　出處：《中國藥房》2017年24期

【摘要】：目的:觀察谷氨酰胺聯(lián)合低分子肝素治療老年重癥肺炎(SP)的療效和安全性。方法:回顧性分析88例老年SP患者資料,按治療方案的不同分為對(duì)照組(44例)和觀察組(44例)。在常規(guī)治療的基礎(chǔ)上,對(duì)照組患者鼻飼腸內(nèi)營養(yǎng)混懸液;觀察組患者在對(duì)照組治療的基礎(chǔ)上給予丙氨酰谷氨酰胺注射液20 g,以至少1∶5的比例溶入氨基酸溶液中,最大濃度不應(yīng)超過3.5%,靜脈滴注,每日1次+低分子肝素鈣注射液4 KU/kg,每日1次,皮下注射。兩組均治療7 d。觀察兩組患者的臨床療效,術(shù)后恢復(fù)情況[呼吸機(jī)支持時(shí)間、肺部Up音消失時(shí)間、重癥監(jiān)護(hù)室(ICU)住院時(shí)間],治療前后免疫球蛋白A(IgA)、IgG、腫瘤壞死因子α(TNF-α)、超敏C反應(yīng)蛋白(hs-CRP)、急性生理和慢性健康狀況Ⅱ(APACHEⅡ)評(píng)分、凝血功能指標(biāo)[活化部分凝血酶原時(shí)間(APTT)、D-二聚體(D-D)、纖維蛋白原(FIB)、凝血酶原時(shí)間(PT)、血小板計(jì)數(shù)(PLT)]、血?dú)夥治鲋笜?biāo){二氧化碳分壓[pa(CO_2)]、血氧飽和度(SpO_2)、氧合指數(shù)(Oi)、血氧分壓[pa(O_2)]}、糖基化終產(chǎn)物受體(RAGE)水平及不良反應(yīng)發(fā)生情況。結(jié)果:觀察組患者總有效率(90.91%)顯著高于對(duì)照組(72.73%),呼吸機(jī)支持時(shí)間、肺部Up音消失時(shí)間、ICU住院時(shí)間均顯著短于對(duì)照組,不良反應(yīng)發(fā)生率顯著低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。治療后,兩組患者IgA、IgG、Oi、SpO_2、pa(O_2)均顯著高于同組治療前,且觀察組顯著高于對(duì)照組;兩組患者TNF-α、hs-CRP、APACHEⅡ評(píng)分、凝血功能指標(biāo)、pa(CO_2)、RAGE水平均顯著低于同組治療前,且觀察組顯著低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 :在常規(guī)治療的基礎(chǔ)上,谷氨酰胺聯(lián)合低分子肝素治療老年SP的療效顯著,可有效改善細(xì)胞免疫功能、凝血功能和血?dú)夥治鲋笜?biāo),降低RAGE水平,且安全性較好。
[Abstract]:Objective: to observe the efficacy and safety of glutamine combined with low molecular weight heparin (LMWH) in the treatment of severe pneumonia in the elderly. On the basis of routine treatment, the patients in the control group were divided into two groups: the control group (n = 44) and the observation group (n = 44). On the basis of routine treatment, the patients in the control group received nasal feeding enteral nutrition suspension. Patients in the observation group were given alanine glutamine injection 20 g on the basis of treatment in the control group and dissolved in amino acid solution at least 1:5. The maximum concentration should not exceed 3.5%. Low molecular weight heparin calcium injection (4 KU / kg, once a day, subcutaneously) was given once a day. The clinical efficacy and postoperative recovery were observed in both groups for 7 days. Before and after treatment, the scores of immunoglobulin A (IgA) IgA, tumor necrosis factor 偽 (TNF- 偽), hypersensitive C-reactive protein (hs-CRP), acute physiological and chronic health status 鈪，

本文編號(hào)：1662577