抗凝治疗在慢性阻塞性肺疾病急性加重期的应用分析  

Analysis of the application of anticoagulant therapy in the acute exacerbation of chronic obstructive pulmonary disease

作　　者：林朱森[1] 刘树元[1] 胡媛琴[1] 

机构地区：[1]海军总医院急诊科,北京100048

出　　处：《中国医学前沿杂志（电子版）》2016年第3期93-96,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨抗凝治疗在慢性阻塞性肺疾病急性加重期的临床效果。方法将112例慢性阻塞性肺疾病急性加重期患者随机分为观察组与对照组,每组各56例。对照组患者给予常规治疗,观察组患者在对照组治疗基础上加用低分子肝素钙治疗。对比两组患者临床治疗有效率、治疗前后凝血功能及肺功能。结果两组患者临床治疗有效率比较差异无显著性(P>0.05)。治疗后观察组患者活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)均较治疗前显著延长(P<0.01),对照组患者无明显变化,观察组上述指标均显著长于对照组(P<0.01);治疗后观察组患者纤溶酶-抗纤溶酶复合物(PAP)水平较治疗前升高,且高于对照组(P<0.01)。治疗后两组患者D-二聚体(DD)水平均显著降低(P<0.01),且观察组显著低于对照组(P<0.01)。治疗前两组患者用力肺活量(FVC)、第一秒用力呼气量(FEV_1)、FEV_1占FVC百分比(FEV1/FVC)、动脉血二氧化碳分压(Pa CO2)及动脉血氧分压(Pa O_2)水平比较均无显著差异(P>0.05)。治疗后两组患者FVC、FEV_1、FEV_1/FVC及Pa O_2水平均较治疗前显著升高(P<0.01),且观察组显著高于对照组(P<0.01);治疗后两组患者Pa CO2水平均较治疗前显著降低(P<0.01),且观察组显著低于对照组(P<0.01)。结论慢性阻塞性肺疾病急性加重期患者由于长期缺血缺氧造成低氧、高碳酸血症,血液呈高凝状态,抗凝治疗可有效缓解该状态,改善患者肺功能及缺氧、酸中毒状态,值得推广应用。Objective To discuss the clinical effects of anticoagulant therapy in the acute exacerbation of chronic obstructive pulmonary disease. Method 112 patients with acute exacerbation of chronic obstructive pulmonary disease were randomly divided into observation group and control group, 56 cases in each group, control group patients were treated with conventional therapy, observation group patients were treated with low molecular heparin calcium. The effective rates, coagulation function and pulmonary function were compared between the two groups. Result There was no significantly difference in the effective rate between the two groups（P 0.05）. APTT and PT in observation group were significantly extended after treatment（P 0.01）, and significantly longer than control group（P 0.01）, PAP levels was incresed in observation group after treatment, and was higher than control group（P 0.01）, DD levels were significantly declined in the two groups after treatment（P 0.01）, and observation group was significantly lower than control group（P 0.01）. Before treatment, the two groups of patients with forced vital capacity（FVC）, the first second forced expiratory volume（FEV_1）, FEV_1/FVC, arterial carbon dioxide partial pressure（Pa CO_2） and arterial oxygen partial pressure（Pa O_2） levels had no significant differences（P 0.05）. The levels of FVC, FEV_1, FEV_1/FVC and Pa O_2 were significantly higher in the two groups after treatment than before treatment（P 0.01）, observation group was significantly higher than control group（P 0.01）. After treatment, the levels of Pa CO_2 in the two groups were significantly lower than before treatment（P 0.01）, and observation group was significantly lower than control group（P 0.01）. Conclusion Blood circulation is hypercoagulable state in patients with acute exacerbation of chronic obstructive pulmonary disease due to long-term hypoxia ischemia and hypercapnia, and anticoagulant therapy can effectively relieve the state and improve lung func

关 键 词：抗凝治疗 慢性阻塞性肺疾病 急性加重期 

分 类 号：R563.9[医药卫生—呼吸系统]