低分子肝素对44例肺心病急性发作伴呼吸衰竭患者的临床疗效评价

目的分析并评价低分子肝素治疗肺心病急性发作伴呼吸衰竭患者的临床效果。方法根据随机分组方法将厦门大学附属第一医院思明分院于2010年9月至2012年12月收治的87例肺心病急性发作伴呼吸衰竭患者分成观察组44例,对照组43例,全部患者均给予常规治疗,观察组在常规治疗基础上给予每日2次皮下注射5000 U低分子肝素钙,对患者的气喘、发绀、心率、水肿、肺部啰音改善状况等指标进行分析。结果观察组23例病情缓解,对照组仅13例;观察组12例病情减轻,对照组为9例;观察组2例无效,对照组6例无效。两组临床疗效经秩和检验后差异具有统计学意义(u=20.397,P=0.012)。观察组的病死率为4.54%(2/44)例,对照组病死率为18.61%(8/43),观察组的病死率显著低于对照组(χ2=4.324,P=0.035)。观察组的心肺功能改善显著优于对照组,其PaCO2值、全血高切黏度以及血细胞比容降低,PaO2值升高。结论应用低分子肝素钙治疗肺心病急性发作伴呼吸衰竭患者可有效改善其通气状况与血液性状,提升心肺功能,降低病死率,提倡临床推广。

Clinical Evaluation of Low Molecular Weight Heparin on 44 Cases of Acute Attack of Pulmonary Heart Disease with Respiratory Failure

Objective To analyze and evaluate the clinical outcome of low molecular weight heparin in the treatment of acute attack of pulmonary heart disease with respiratory failure.Methods According to the random grouping method 87 patients with acute attack of pulmonmy heart disease with respiratmy failure admitted to Siming Department of Xiamen Univmsity Affiliated First Hospital during Sep.2010 and Dec.2012 were divided into observation group of 44 cases,and control group of 43 cases,all the patients were given conventional treatment,while the observation group was also given subcutaneous injection of 5000 IU of low molecular weight heparin calcium 2 times daily,then the asthma,cyanosis,heart rate,edema,rales improvement status indexes were analyzed.Results There were 23 cases of remission in observation group,13 cases in control group; 12 cases of alleviation in observation group,9 cases in control group; 2 cases of ineffective in observation group,6 cases in control group.The clinical efficacy of the two groups had significant differ ence by rank sum test（u =20.397,P =0.012）.The mortality rate of observation group was 4.54% （2/44）,significantly higher than the 18.61% （8/43） of control group（x2 =4.324,P=0.035）.The heart and lung function of observation group improved more significantly than the control group,the PaCO2 value,whole blood viscosity and hematocrit decreased,PaO2 value increased.Conclusion Low molecular weight heparin calcium as treatment for acute attack of pulmonary heart disease with respiratory failure patients can effectively improve the ventilation and blood characteristics,improve heart and lung function,and reduce the mortality,which should be promoted in clinical.