慢性阻塞性肺疾病急性加重疑诊合并肺栓塞的抗凝治疗临床分析

目的 探讨对重度慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)疑诊合并肺栓塞(PE)患者进行抗凝治疗的有效性和安全性.方法 将D-二聚体阳性的37例重度AECOPD患者分为血氧分压正常组(A组)和血氧分压降低组(B组),并对两组患者进一步随机分为抗凝(A1、B1)和非抗凝(A2、B2)两个亚组.分别观察和评估A组和B组抗凝和非抗凝治疗的临床变化.结果 B1,组和B2组比较:临床症状改善、动脉血气分析、D-二体和机械通气时间等比较差异有统计学意义(P＜0.05),两组并发症比较差异无统计学意义(P＞0.05),B1组优于B2组·结论具有静脉血栓栓塞高危因素或临床高度可疑PE、D-二体检测阳性的重度AECOPD机械通气患者,若同时存在低氧血症,特别是存在经持续鼻导管吸氧或无创机械通气难以纠正的低氧血症时,在排除急性左心衰和气胸后,不必等待CTPA或核素肺通气/灌注显像检查确诊,而应当即刻开始给予常规抗凝治疗.

Clinical analysis of anticoagulation for acute exacerbation of chronic obstructive pulmonary disease with co-existing suspected acute pulmonary embolism

Objective To investigate the efficacy and safety of the anticoagulation for acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with co-existing suspected acute pulmonary embolistn(PE).Methods Thirty-seven severe AECOPD inpatients with a positive D-dimer assay were divided into A group(a value of PaO2 was normal)and B group(hypoxia).The two groups were randomlv redistributed into anticoagulation subgroups(A1 and B1)and non-anticoagulation subgroups(A2 and B2).The consequences of the management were surveyed and assessed.Results Bi subgroup versus B2 subgrouP:there were significant differences in dyspnea,PaO2,D-dimer and ventilating time(P<0.05).There was not significant difference in complications with anticoagulation(P>0.05).B1 subgroup was preferable to B2 subgroup.Conclusions Anticoagulation should immediately be given to patients with severe AECOPD who do not require further investigation of CTPA or isotope lung scanning for confirming PE,providing the patients have risk factors for venous thromboembolism or high probability for PE,and a positive D-dimer test,and receiving mechanic ventilation,and existing hypoxia,even SO be given oxygen or received non-invasive mechanic ventilation,and acute left heart failure and pneumothorax were excluded.