低分子肝素改善COPD急性加重期的价值研究

目的观察低分子肝素治疗COPD急性加重期的临床价值,以期为COPD急性加重期的治疗提供借鉴。方法选取2011年4月至2014年6月来我院就诊的60例COPD急性加重期患者为研究对象,根据治疗方式随机分为2组,即观察组和对照组,每组30例。两组患者均予以低流量吸氧、解痉平喘、祛痰止咳、抗感染,必要时给予糖皮质激素和机械通气等对症治疗;观察组在此基础上加用低分子肝素。观察患者的凝血指标和动脉血气分析的变化。结果治疗前,两组患者性别、年龄、凝血指标、动脉血气指标等比较差异无统计学意义(P>0.05)。治疗后,两组患者PT、TT、APTT、FIB、D-二聚体、氧分压(PaO_2)、二氧化碳分压(PaCO_2)较治疗前均有明显改善(P<0.05),观察组各指标改善优于对照组(P<0.05)。血浆FIB(r=-0.311,P<0.05)、D-二聚体(r=-0.325,P<0.01)与PaO_2呈负相关;血浆FIB(r=0.550,P<0.01)、D-二聚体(r=0.577,P<0.01)与PaCO_2呈正相关;PT、APTT、TT与PaO_2、PaCO_2无明显相关性(P>0.05)。结论加用低分子肝素治疗COPD急性加重期,能明显降低血浆FIB、D-二聚体水平,提高PaO_2,值得推广。

Value of low molecular weight heparin in acute exacerbation of COPD

Objective To observe the clinical value of low molecular weight heparin in the treatment of acute exacerbation of COPD,in order to provide references for the treatment of acute exacerbation of COPD. Methods Sixty patients with acute exacerbation of COPD from April 2011 to June 2014 in our hospital were selected and randomly di-vided into observation group (n=30) and control group (n=30). All the patients were treated with low-flow oxygen, antispasmodic,expectorant cough,antibiotics,corticosteroids and mechanical ventilation. Observation group was added with low-molecular-weight heparin. The changes of coagulation parameters and arterial blood gas analysis were ob-served. Results There was no significant difference in gender ratio,age,coagulation or arterial blood gas indicators be-tween the two groups before treatment(P>0. 05). After treatment,PT,TT,APTT,FIB,D-dimer,partial pressure of ox-ygen (PaO2) and carbon dioxide partial pressure (PaCO2) of the two groups were significantly improved (P<0. 05), and there were significant differences between the 2 groups(P <0. 05). The levels of plasma FIB (r =-0. 311,P<0. 05) and D-dimer (r=-0. 325,P<0. 01) were negatively correlated with PaO2;while they were positively correlated with PaCO2(r=0. 550,P<0. 01;r=0. 577,P<0. 01);PT,APTT,TT and PaO2,PaCO2 showed no significant correla-tion (P>0. 05). Conclusion The addition of low-molecular-weight heparin in the treatment of acute exacerbation of COPD can significantly reduce the levels of plasma FIB and D-dimer,increase the PaO2 ,and it is worthy of promotion.