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谷氨酰胺联合低分子肝素治疗老年重症肺炎的临床观察
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| 篇名： | 谷氨酰胺联合低分子肝素治疗老年重症肺炎的临床观察 |
| TITLE： | |
| 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、肺部啰音消失时间、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（CO2）]、血氧饱和度（SpO2）、氧合指数（Oi）、血氧分压[pa（O2）]｝、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、肺部啰音消失时间、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（P＜0.05）。治疗后，两组患者IgA、IgG、Oi、SpO2、pa（O2）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（CO2）、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（P＜0.05）。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 therapeutic efficacy and safety of glutamine combined with low molecular weight heparin in the treatment of elderly severe pneumonia （SP）. METHODS： In retrospective study， 88 SP elderly patients were divided into control group （44 cases） and observation group （44 cases）. Based on conventional treatment， control group was given Enteral nutritional suspension via nasal feeding. Observation group was additionally given Alanyl glutamine injection 20 g， dissolved in Amino acid solution with ratio of 1 ∶ 5 at least and maximum concentration belowing 3.5％， i.v.， once a day+Low molecular weight heparin calcium injection 4 KU/kg subcutaneously， once a day， on the basis of control group. Both groups were treated for 7 d. Clinical efficacies and postoperative recovery （ventilator support time， pulmonary rale disappearance time and ICU hospitalization time） were observed in 2 groups. The levels of IgA， IgG， TNF-α， hs-CRP， APACHEⅡ score， coagulation function indexes （APTT， D-D， FIB， PT， PLT）， blood gas analysis indexes [pa（CO2）， SpO2， Oi， pa（O2）] and receptor for advanced glycation end products （RAGE）， the occurrence of ADR before and after treatment were also observed in 2 groups. RESULTS： Total response rate of observation group （90.91％） was significantly higher than that of control group （72.73％）， while ventilator support time， pulmonary rale disappearance time and ICU hospitalization time were significantly shorter than control group； the incidence of ADR was significantly lower than control group， with statistical significance （P＜0.05）. After treatment， the levels of IgA， IgG， Oi， SpO2 and pa（O2） in 2 groups were significantly higher than before treatment， and the observation group was significantly higher than the control group. The levels of TNF-α， hs-CRP， APACHEⅡ score， coagulation function indexes， pa（CO2） and RAGE in 2 groups were significantly lower than before， and the observation group was significantly lower than the control group， with statistical significance （P＜0.05）. CONCLUSIONS： Based on conventional treatment， glutamine combined with low molecular weight heparin show significantly effect on elderly SP， effectively improve cellular immune function， coagulation function and blood gas analysis indexes and reduce RAGE level with good safety. |
| 期刊： | 2017年第28卷第24期 |
| 作者： | 张红梅，唐树芝，武海英，胡国志 |
| AUTHORS： | ZHANG Hongmei，TANG Shuzhi，WU Haiying，HU Guozhi |
| 关键字： | 老年重症肺炎；低分子肝素；谷氨酰胺；疗效；安全性 |
| KEYWORDS： | Elderly severe pneumonia； Low molecular weight heparin； Glutamine； Therapeutic efficacy； Safety |
| 阅读数： | 310 次 |
| 本月下载数： | 3 次 |
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