低分子肝素对重症慢性阻塞性肺疾病急性加重伴呼吸衰竭病人血栓弹力图的影响  

Effect of low molecular weight heparin on thromboela-stogram in patients with severe AECOPD complicated with respiratory failure

作　　者：季伟[1] 鲍磊[1] 肖峰[1] 秦海东[1] JI Wei;BAO Lei;XIAO Feng;QIN Hai-dong(Department of Emergency,the Affiliated Nanjing Hospital of Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)急诊科,江苏省南京市210006

出　　处：《实用老年医学》2018年第8期770-772,776,共4页Practical Geriatrics

摘　　要：目的观察慢性阻塞性肺疾病急性加重(AECOPD)病人血栓弹力图的变化,探讨低分子肝素对重症AECOPD的临床治疗效果。方法选择诊断为AECOPD并行有创机械通气的病人共48例,随机分为常规治疗组(对照组)及低分子肝素治疗组(治疗组),每组24例。对照组按AECOPD治疗指南给予常规呼吸支持、抗感染、化痰、平喘等治疗。低分子肝素治疗组在常规治疗的基础上应用低分子肝素4100 U静脉持续泵入。观察2组病人急性生理与慢性健康评分(APACHEⅡ)、机械通气时间、血气分析、血栓弹力图及D-二聚体的变化。结果(1)治疗前2组凝血因子反应时间均低于正常值,纤维蛋白原反应时间和D-二聚体水平均高于正常值,提示病人血液存在高凝状态。治疗7 d后,治疗组凝血因子反应时间升高幅度大于对照组,纤维蛋白原反应时间及D-二聚体降低幅度大于对照组(P<0.05)。(2)治疗7 d后,治疗组p H、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)改善情况优于对照组;APACHEⅡ评分下降幅度大于对照组(P<0.05)。(3)治疗组呼吸机使用时间少于对照组,差异有统计学意义(P<0.05)。结论低分子肝素能够显著改善重症AECOPD病人血栓弹力图、D-二聚体及血气分析指标,减少病人呼吸机使用时间,提高病人APACHEⅡ评分,改善预后。Objective To observe the changes of thromboela-stogram of patients with severe acute exacerbations of chronic obstructive pulmonary disease（ AECOPD） complicated with respiratory failure,and to investigate the clinical effect of low molecular weight heparin（ LMWH） for the treatment of AECOPD. Methods Forty-eight patients with AECOPD receiving injured mechanical ventilation were randomly divided into control group（ treated with conventional treatment） and treatment group（ receiving LMWH additionally）. Control group was given invasive mechanical ventilation, antibiotics,bronchodilator and phlegm removing. Patients in treatment group was injected with 4100 U of LMWH on the basis of control group. The changes of APACHE Ⅱ score,mechanical ventilation time,blood gas analysis,thrombela-stogram and D-dimer of the two groups were detected and compared. Results The time of coagulation reaction factor in the two groups before treatment was lower than that of normal person,and the time of fibrinogen reaction and the D-dimeric were higher than those of normal. After 7 days of treatment,the reaction time of clotting factor in treatment group was higher than that of control group,and the decrease of D-dimer and the time of fibrinogen reaction was more significant than that of control group（ P〈0. 05）. After 7 days of treatment,p H,Pa O2 and Pa CO2 in treatment group were better than those in control group. The decrease of APACHE Ⅱ score was more significant than control group（ P〈0. 05）. Treatment group had less ventilator use time than control group（ P〈0. 05）. Conclusions Low molecular weight heparin can significantly improve the thromboembolic strategy,D-dimer,blood-gas analysis indicators in patients with severe AECOPD,reduce the time of ventilator use,and improve the APACHE Ⅱ score,thereby improving the prognosis.

关 键 词：慢性阻塞性肺疾病急性加重 血栓前状态 血栓弹力图 低分子肝素 

分 类 号：R563[医药卫生—呼吸系统]