低分子肝素钙对慢性阻塞性肺疾病急性加重期患者血栓前状态的影响

目的探讨低分子肝素钙抗凝治疗对慢性阻塞性肺疾病急性加重期(AECOPD)患者血栓前状态(PTS)的影响及其临床意义。方法将84例AECOPD患者随机分为2组,对照组36例给予常规治疗,观察组48例在常规治疗的基础上加用低分子肝素钙5 000 U皮下注射,每12 h 1次,疗程7 d。检测2组患者治疗前后血浆D-二聚体(DD)、纤维蛋白原(FIB)、血小板颗粒膜蛋白140(GMP-140)、血管性血友病因子(vWF)、同型半胱氨酸(Hcy)和动脉血气分析。结果治疗前2组DD、FIB、GMP-140、vWF和Hcy水平比较差异均无统计学意义(P>0.05);与治疗前比较,对照组治疗后DD水平显著下降(P<0.05),而FIB、GMP-140、vWF及Hcy水平无明显变化(P>0.05);观察组治疗后DD、FIB、GMP-140、vWF和Hcy水平均显著下降(P<0.05);治疗后观察组DD、FIB、GMP-140、vWF和Hcy水平显著低于对照组(P<0.05)。治疗前2组动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)比较差异均无统计学意义(P>0.05);与治疗前比较,2组治疗后PaO2升高(P<0.05),PaCO2下降(P<0.05);治疗后观察组PaO2高于对照组(P<0.05),PaCO2低于对照组(P<0.05)。观察组总有效率高于对照组(P<0.05)。结论 AECOPD患者存在PTS,低分子肝素钙抗凝治疗可改善患者PTS。

Effect of low molecular weight heparin calcium on the prethrombotic state in patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To investigate the effect and significance of low molecular weight heparin calcium on the prethrombotic state(PTS) in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Eighty-four patients with AECOPD were randomly divided into two group.Thirty-six patients in control group were treated with the conventional therapy,based on this,forty-eight patients in observation group were treated with low molecular weight heparin calcium 5 000 U by hypodermic injection every twelve hours for seven days.The indexes of D dimer(DD),fibrinogen(FIB),granular membrane protein-140(GMP-140),von willebrand factor(vWF),homocysteine(Hcy) and arterial blood gas were detected before and after therapy in two groups.Results There was no statistical significance in the levels of DD,FIB,GMP-140,vWF and Hcy between two groups before therapy(P>0.05).Compared with control group,DD significantly decreased after treatment in control group(P<0.05),but the levels of FIB,GMP-140,vWF and Hcy in control group showed no statistical significance after therapy(P>0.05);the levels of DD,FIB,GMP-140,vWF and Hcy in observation group significantly decreased after treatment(P<0.05).The levels of DD,FIB,GMP-140,vWF and Hcy in observation group after therapy were significantly lower than those in control group(P<0.05).There was no statistical significance in arterial partial pressure of oxygen(PaO2) and arterial partial pressure of carbon dioxide(PaCO2) between two groups before therapy(P>0.05).Compared with pretreatment,PaO2 was obviously increased(P<0.05),and PaCO2 was significantly decreased after therapy in two groups(P<0.05).Compared with control group,PaO2 was significantly increased(P<0.05),and PaCO2 was significantly decreasedin observation group after therapy(P<0.05).The total effective rate in observation group was higher than that in control group(P<0.05).Conclusion PTS exists in patients with AECOPD and low molecular weight heparin calcium anticoagulation therapy can improve PTS.