慢性阻塞性肺疾病急性加重期抗凝治疗的临床价值

Clinical value of anticoagulant therapy in acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病（COPD）急性加重期应用抗凝治疗的临床意义。方法65例入住综合加强治疗病房的COPD急性加重期患者随机分为治疗组（抗凝）32例，对照组33例，两组病人均常规给予氧疗（不包括有创呼吸机辅助通气）、抗感染、雾化祛痰、解痉平喘、营养支持等治疗，治疗组同时给予低分子肝素治疗1周。治疗前后分别取静脉血，测量血浆中降钙素原（PCT）、白介素-6（IL-6）、C-反应蛋白浓度（CRP）。结果抗凝治疗结束后，治疗组的红细胞压积较对照组好转，好转时间及住院时间缩短，血浆中纤维蛋白原、PCT、IL-6、CRP浓度较对照组下降，两组比较差异均有统计学意义。结论抗凝治疗可以改善COPD急性加重期患者的红细胞压积，降低纤维蛋白原含量，减少炎症因子的生成，对COPD急性加重期的治疗有很高的临床价值。

Objective To study the clinical value of anticoagulant therapy in acute exacerbation of chronic obstructive pulmonary disease （COPD）. Methods 65 patients admitted to the ICU were divided into treatment group （anticoagulant therapy, n=32） and control group （n=33）. Both groups conventionally received oxygen therapy （excluding invasive ventilator-assisted ventilation）, anti-infection therapy, atomization expectorants, spasmolysis, antiasthmatic therapy and nutritional support. At the same time, the treatment group was treated with low-molecular-weight heparin for a week. The levels of plasma procalcitonin, C-reactive protein and interleukin-6 were measured. Results After anticoagulant therapy for a week, hematocrit in the treatment group improved more significantly than that in the control group, and the time of improvement and length of stay in hospital were shortened. Plasma fibrinogen, procalcitonin, C-reactive protein and interleukin-6 levels were significantly decreased. Conclusion Anticoagulant therapy has important clinical value in the treatment of acute exacerbation of COPD through improving hematocrit and reducing fibrinogen and generation of inflammatory factors.