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1、小剂量肝素联合治疗重症肺炎的观察研究【摘要】目的探讨联合小剂量肝索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200U/（kg?d）普通肝索分次皮下或静脉给药、连续使用7d；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
2、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）o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。【关键词】重症肺炎；肝索D0I：10.14163/j.cnki.11-5547/r.2015.18.008ObservationandresearchofsmalldoseofheparinincombinedtreatmentofseverepneumoniaLTNMei-rui,CHENXiao-hong,LTNChen.Depart
3、ment,ofIntensiveMedicine,TheFirstAffiliatedHospitalofMedicalCollegeofShantouUniversity,Shantou515000,China【Abstract】ObjectiveToinvestigatethesafetyandeffectivenessofcombinedtreatmentbysmalldoseofheparinforseverepneumonia.MethodsAtotalof32diagnosedseverepneumoniapatientswithoutcontraindic
4、ationforheparinwererandomlydividedintotreatmentgroupandcontrolgroup,with16casesineachgroup.Thetreatmentgroupreceived200U/(kg?d)ofheparinbyfractionalsubcutaneousorintravenousadministrationfor7d・Thecontrolgroupreceivedplacebo.Acutephysiologyandchronichealthevaluation(APACHEIIscore),oxygena
5、tionindex,bloodplateletcount,activatedpartialthromboplastintime(APTT),fibrinogen(FBG),whitebloodcount(WBC),andC-reactiveprotein(CRP)ofthetwogroupsweremonitoredbeforeandaftertreatment・TheirtotalhospitalstayandICUtimewereobserved.ResultsAfter1weekoftreatment,thetreatmentgrouphadmoreobvious
6、lyincreasedoxygenationindexanddecreasedCRPlevelthanthecontrolgroup.Thedifferenceshadstatisticalsignificance(allP<0.01)•ThetreatmentgrouphadmoredecreasedAPACHEIIscorethanthecontrolgroup,andtheirdifferencehadstatisticalsignificance(P<0.05)•ConclusionCombinedtreatmentbysmal1doseofheparinfor
7、severepneumoniacanobviouslyimproveoxygenationindexandreduceinflammatorymediatorlevelandAPACHEIIscoreofpatienls.[Keywords]Severepneumonia；Heparin重症肺炎是呼吸系统疾病中常见的由感染导致的危重病症，易出现多种严重并发症，甚至危及生命，重症肺炎因可引起组织缺氧，血管内皮损伤，血小板活化等而导致机体出现高凝状态［1］,严重者甚至可导致弥散性血管内凝血（DTC）,早期即干预异常的凝血状态，阻断其病理发展，
