老年慢性阻塞性肺疾病急性加重期患者凝血功能的监测

目的研究老年慢性阻塞性肺疾病急性加重期(AECOPD)与AECOPD伴呼吸衰竭患者凝血检测的临床意义。方法抽选2013年5月至2014年5月我院收治的老年AECOPD患者96例,按照是否伴呼吸衰竭分为呼衰组(n=44)和AECOPD组(n=52),并选择同期在我院行健康体检并确认健康者50例作为对照组。采用Sysmex XE-5000全自动血细胞分析仪和Sysmex CS-5100全自动凝血分析仪检测三组患者凝血指标:血小板(PLT)、D二聚体(D-D)、血浆纤维蛋白原(Fbg)、血浆凝血酶原时间(PT)、活化部分凝血酶原时间(a PTT);检测炎症指标:C反应蛋白(CRP)、白细胞计数(WBC);采用肺功能检测仪检测用力呼气肺活量(FVC)、第一秒用力呼气容积(FEV1)及血气指标Pa O_2、Pa CO_2。结果呼衰组D-D水平显著高于AECOPD组和对照组,且AECOPD组高于对照组,(P0.05);AECOPD组、呼衰组Fbg水平均高于对照组(P0.05),但两组组间比较无统计学差异(P0.05)。呼衰组、AECOPD组CRP、TNF-α、IL-8水平均高于对照组,且呼衰组显著高于AECOPD组,差异均有统计学意义(P0.05)。呼衰组FEV1、FEV1/FVC、Pa O_2水平均低于AECOPD组低于对照组;Pa CO_2高于AECOPD组高于对照组,组间比较差异均有统计学意义(P0.05)。结论AECOPD伴呼吸衰竭患者存在高凝状态。

Blood Coagulation Test in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective To study the clinical significance of blood coagulation test in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)and AECOPD complicated by respiratory failure.Methods 96 cases of elderly patients with AECOPD who were treated in our hospital between May 2013 and May 2014 were enrolled in the study.According to with or without respiratory failure,the patients were divided into the control group (n =44) and AECOPD group (n =52).50 cases who were confirmed healthy by health examination in our hospital during the same period were included in the control group.The coagulation indexes in the three groups were determined by Sysmex CS-5100 automated coagulation analyzer,including platelet (PLT),D-Dimer (D-D),plasma fibrinogen (Fbg),prothrombin time (PT) and activated partial thromboplastin time (aPTT);The inflammatory indexes,including C-reactive protein (CRP),),white blood cell count (WBC)were also detected;The forced vital capacity (FVC),forced expiratory volume in 1 second(FEV1)and blood gas indexes(PaO2,PaCO2) were detected by the pulmonary function detector.Results The D-D level in respiratory failure group was significantly higher than that in AECOPD group and control group and that in AECOPD group was higher than that in the control group(P ＜0.05);Fbg levels in AECOPD group and control group were significantly higher than those in control group (P＜0.05),but there was no significant difference between any two groups(P ＞0.05).The levels of CRP,TNF-α and IL-8 in the respiratory failure group and AECOPD group were higher than those in the control group,and those in the respiratory failure group were significantly higher than those in AECOPD group(P ＜0.05).The levels of FEV1,FEV1 / FVC and PaO2 in the respiratory failure group were lower than those in AECOPD group and the control group while PaCO2 level was higher than that in AECOPD group and the control group (P ＜ 0.05).Conclusion There are high coagulation state in patients with AECOPD complicated by respiratory failure