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目的探讨联合小剂量肝素治疗重症肺炎的安全性及有效性。方法 32例诊断明确、没有肝素使用禁忌证的重症肺炎患者采用随机对照分组的办法分为治疗组及对照组,各16例。治疗组同时应用200 U/(kg·d)普通肝素分次皮下或静脉给药、连续使用7 d;对照组给予安慰剂处理。监测两组患者治疗前后的急性生理与慢性健康评分(APACHEⅡ评分)、氧合指数、血小板计数、活化部分凝血活酶时间(APTT)、纤维蛋白原(FBG)、白细胞计数(WBC)、C反应蛋白(CRP)等指标;并观察总住院时间、ICU住院时间等。结果治疗1周后治疗组氧合指数较对照组有明显改善,CRP水平则较对照组有明显下降,差异有统计学意义(P均<0.01);APACHⅡ评分较对照组降低,差异有统计学意义(P<0.05)。结论联合小剂量肝素治疗可明显改善重症肺炎患者氧合及降低炎症介质的水平,降低APACHEⅡ评分。
Objective To investigate the safety and efficacy of combined low-dose heparin in the treatment of severe pneumonia. Methods Thirty-two patients with severe pneumonia who were diagnosed without contraindications to heparin treatment were divided into treatment group (n = 16) and control group (n = 16) by randomized controlled group. The treatment group also applied 200 U / (kg · d) of unfractionated heparin subcutaneously or intravenously, for 7 consecutive days; the control group was given placebo. Acute physiology and chronic health scores (APACHE II), oxygenation index, platelet count, activated partial thromboplastin time (APTT), fibrinogen (FBG), white blood cell count (WBC) Protein (CRP) and other indicators; and to observe the total length of stay, hospital stay and other ICU. Results After 1 week of treatment, the oxygenation index of the treatment group was significantly improved compared with that of the control group. The CRP level was significantly lower than that of the control group (P <0.01), and the APACH Ⅱ score was lower than that of the control group Significance (P <0.05). Conclusions Combination of low-dose heparin therapy can significantly improve the oxygenation of patients with severe pneumonia and reduce the level of inflammatory mediators and reduce the APACHEⅡscore.