低分子肝素抗凝对慢性阻塞性肺疾病急性加重期患者肺通气、凝血功能和血NLR、PLR、NSE水平的影响  

Effects of Low Molecular Weight Heparin Anticoagulation on Pulmonary Ventilation,Coagulation Function,Serum NLR,PLR and NSE Levels in Patients with AECOPD

作　　者：杨婵娟[1] 王贝 吴苏 管弦[1] 李俊[1] 徐维彬 YANG Chanjuan;WANG Bei;WU Su;GUAN Xian;LI Jun;XU Weibin(Department of Respiratory and Critical Care Medicine,Meishan People's Hospital,Meishan,Sichuan 620010,China)

机构地区：[1]眉山市人民医院呼吸与危重症医学科,四川眉山620010

出　　处：《转化医学杂志》2024年第7期994-999,共6页Translational Medicine Journal

基　　金：眉山市科技指导性计划项目(2023KJZD005)。

摘　　要：目的探究低分子肝素(LMWH)抗凝对慢性阻塞性肺疾病急性加重期(AECOPD)患者肺通气、凝血功能及血中性粒细胞/淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)、神经元特异性烯醇化酶(NSE)水平的影响。方法选取2022年6月至2024年3月眉山市人民医院收治的65例AECOPD患者为研究对象,按照随机数表法将患者分为LMWH组(33例)与常规组(32例)。常规组患者接受吸氧、抗感染等常规对症治疗,LMWH组在常规组的基础上联合LMWH皮下注射。治疗1周后,评估2组患者临床疗效;治疗前后测定2组患者肺通气、凝血功能、血NLR、PLR与NSE等指标。结果LMWH组总有效率为93.94%,显著高于常规组的71.88%,差异有统计学意义(P<0.05)。治疗后,2组第1秒用力呼气容积、用力肺活量、最大呼气峰流速、动脉血氧分压、氧饱和度显著高于治疗前,且LMWH组各项均高于常规组,差异均有统计学意义(P<0.05)。治疗后,LMWH组动脉血二氧化碳分压(PaCO_(2))显著低于治疗前,且LMWH组PaCO_(2)低于常规组,差异有统计学意义(P<0.05)。治疗后,2组纤维蛋白原、D-二聚体、NLR与PLR、NSE水平显著低于治疗前,且LMWH组各项均低于常规组,差异有统计学意义(P<0.05)。治疗后,LMWH组活化部分凝血活酶时间、凝血酶原时间较治疗前显著延长,且LMWH组均长于常规组,差异有统计学意义(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论LMWH能明显改善AECOPD患者肺通气与凝血功能,降低血NLR、PLR与NSE水平,安全有效。Objective To investigate the effects of LMWH anticoagulation on pulmonary ventilation,coagulation function,serum neutrophil/lymphocyte ratio(NLR),platelet lymphocyte ratio(PLR)and neuron⁃specific enolase(NSE)levels in AECOPD patients.Methods 65 AECOPD patients admitted to Meishan people's hospital from June 2022 to March 2024 were included into LMWH group(n=33),subcutaneous injection of LMWH based on routine treatment and routine group(n=32),routine symptomatic treatment,such as oxygen inhalation and anti⁃infection by random number table meth⁃od.The curative effect was evaluated after 1 week of treatment.Pulmonary ventilation,coagulation function,serum NLR,PLR and NSE were measured before and after 1 week of treatment.Results The total effective rate was significantly higher in the LMWH group(93.94%)compared to the routine group(71.88%)After 1 week of treatment,forced expiratory volume,forced vital capacity,peak expiratory flow rate,arterial partial oxygen pressure and oxygen saturation in the two groups in⁃creased after treatment,and the LMWH group were higher(P<0.05),while the partial blood pressure of carbon dioxide(PaCO_(2))was significantly lower(P<0.05).After 1 week of treatment,the levels of fibrinogen,D⁃dimer,serum NLR,PLR and NSE in the two groups decreased after treatment,and the LMWH group was lower(P<0.05),while activated partial thromboplastin time and prothrombin time were significantly longer(P<0.05).There was no statistically significant difference in adverse reactions between the two groups(P>0.05).Conclusion LMWH can significantly improve pulmonary ventila⁃tion and coagulation function,and reduce serum NLR,PLR and NSE levels in AECOPD patients,which is safe and effective.

关 键 词：慢性阻塞性肺疾病急性加重期 低分子肝素 肺通气 凝血功能 中性粒细胞/淋巴细胞比值 血小板淋巴细胞比值 神经元特异性烯醇化酶 

分 类 号：R563[医药卫生—呼吸系统]