低分子肝素钙对肺心病急性发作并呼吸衰竭的疗效观察

Clinical observation of low molecular heparin calcium's efficacy on acute attack of pulmonary heart disease and respiratory failure

目的研究低分子肝素钙对肺源性心脏病急性发作并呼吸衰竭的疗效。方法对39例肺心病急性发作并呼吸衰竭患者按随机双盲法分为观察组A20例,对照组B19例,A、B两组的常规治疗如抗感染、氧疗、改善通气、强心、利尿等相同,仅观察组A用低分子肝素钙5000IU于腹壁皮下注射2次/d,10d为1个疗程,监测A、B两组治疗前后血气pH、PaO2、PaCO2,全血高切黏度、红细胞比容及纤维蛋白原,并观察A、B两组临床疗效(水肿、紫绀、哮喘,心率及肺部啰音的变化)及病死率。结果治疗后A组较B组心肺功能明显改善,红细胞比容和全血高切黏度明显降低,PaCO2降低,PaO2明显增高,A组临床总有效率高于B组,A组病死率低于B组。结论低分子肝素钙皮下注射可改善肺心病急性发作并呼吸衰竭患者的心肺功能、血液性状及通气,且能提高临床总有效率,降低病死率。

Objective To study the curative effect of low molecular heparin calcium on acute attack of pulmonary heart disease and respiratory failure. Methods 39 patients suffered from the acute attack of pulmonary heart disease and the respiratory failure were divided into the observation group A 20 and the control group B 19 in accordance with random double blind method ,the normal therapy of A and B groups were the same ,such as anti-infection, oxygen therapy, ventilation improvement, heart stimulation, diuresis and so on, but the observation group A was injected under the abdominal skin with 5 000 IU low molecular heparin calcium twice every day. One treatment course includes 10 days. Then, to observe the blood pH, PaO2 and PaCO2 , whole blood vis cosity at high shear, red blood cell specific volume and fibrinogen after the therapy for A and B groups, and to observe the clinical efficacy （ on dropsy, cyanosis, asthma, the change of heart rate and lung rate） and fatality rate of A and B groups. Results The cardio-pulmonary function of Group A was improved obviously rhite compared with Group B,while the specific volume of red blood cells and the whole blood viscosity at high shear decrease largely, PaCO2 ） reduced and PaO2 rised evidently. The gross clinical efficacy of Group A was higher than that of Group B, while the fatality rate of Group A was lower than that of Group B. Conclusion The subcutaneous injection of low molecular heparin calcium can improve the cardio-pulmonary function, blood property and ventilation of the patients suffered from the acute attack of pulmonary heart disease and respiratory failure, and can increase the gross clinical efficacy and decrease the fatality rate.