谷氨酰胺联合低分子肝素治疗老年重症肺炎的临床观察

发布时间：2018-03-25 09:45

  本文选题：老年重症肺炎　切入点：低分子肝素　出处：《中国药房》2017年24期

【摘要】：目的:观察谷氨酰胺联合低分子肝素治疗老年重症肺炎(SP)的疗效和安全性。方法:回顾性分析88例老年SP患者资料,按治疗方案的不同分为对照组(44例)和观察组(44例)。在常规治疗的基础上,对照组患者鼻饲肠内营养混悬液;观察组患者在对照组治疗的基础上给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,最大浓度不应超过3.5%,静脉滴注,每日1次+低分子肝素钙注射液4 KU/kg,每日1次,皮下注射。两组均治疗7 d。观察两组患者的临床疗效,术后恢复情况[呼吸机支持时间、肺部Up音消失时间、重症监护室(ICU)住院时间],治疗前后免疫球蛋白A(IgA)、IgG、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)、急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分、凝血功能指标[活化部分凝血酶原时间(APTT)、D-二聚体(D-D)、纤维蛋白原(FIB)、凝血酶原时间(PT)、血小板计数(PLT)]、血气分析指标{二氧化碳分压[pa(CO_2)]、血氧饱和度(SpO_2)、氧合指数(Oi)、血氧分压[pa(O_2)]}、糖基化终产物受体(RAGE)水平及不良反应发生情况。结果:观察组患者总有效率(90.91%)显著高于对照组(72.73%),呼吸机支持时间、肺部Up音消失时间、ICU住院时间均显著短于对照组,不良反应发生率显著低于对照组,差异均有统计学意义(P0.05)。治疗后,两组患者IgA、IgG、Oi、SpO_2、pa(O_2)均显著高于同组治疗前,且观察组显著高于对照组;两组患者TNF-α、hs-CRP、APACHEⅡ评分、凝血功能指标、pa(CO_2)、RAGE水平均显著低于同组治疗前,且观察组显著低于对照组,差异均有统计学意义(P0.05)。结论 :在常规治疗的基础上,谷氨酰胺联合低分子肝素治疗老年SP的疗效显著,可有效改善细胞免疫功能、凝血功能和血气分析指标,降低RAGE水平,且安全性较好。
[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 伪 (TNF- 伪), hypersensitive C-reactive protein (hs-CRP), acute physiological and chronic health status 鈪，

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