雾化吸入肝素对AECOPD机械通气患者血气及凝血功能的影响

Effects of aer osol inhalation of heparin on arterial blood gas and coagulation function of patients with acute exacerbation of chronic obstructive pulmonary disease by mechanical ventilation

目的：研究雾化吸入肝素对慢性阻塞性肺疾病急性加重期（ AECOPD ）机械通气患者血气及凝血功能的影响。方法研究设计为随机的、前瞻性的、双盲的、临床干预的对照研究。将46例AECOPD机械通气患者随机分为肝素组（26例）和对照组（20例）。对照组使用0．45％氯化钠溶液10 mL单次雾化吸入；肝素组使用普通肝素钠（12500 IU ＆#215;4支）单次雾化吸入。不同时间点分别监测血气分析值及凝血功能值。结果肝素组动脉血氧分压（ PaO2）、氧合指数（ PaO2/FiO2）、动脉氧饱和度（ SaO2）随着雾化时间的延长逐渐升高，优于对照组（ P＜0．05）；与雾化前比较，第3、5、7天PaO 2、PaO 2/FiO 2、SaO 2呈逐渐上升趋势（P＜0．05）；两组雾化前、第3天动脉二氧化碳分压（ PaCO2）比较差异无统计学意义（P＞0．05），第5、7天PaCO2随着时间的延长组内比较差异有统计学意义（ P＜0．05）；两组雾化前、第7天活化部分凝血活酶时间（ APTT）、凝血酶原时间（PT）、纤维蛋白原（FIB）比较差异无统计学意义（P＞0．05）。结论雾化吸入肝素治疗AECOPD机械通气患者是安全、有效的，可显著提高患者的动脉氧分压，降低二氧化碳分压，且对患者的凝血功能影响较小。

Objective To investigate the effects of aerosol inhalation of heparin on arterial blood gas and coagulation function of patients with acute exacerbation of chronic obstructive pulmonary disease （ AECOPD ） by mechanical ventilation .Methods Patients were collected for the prospective and double -blind clinical intervention . Forty six mechanically ventilated AECOPD patients were randomly divided into two groups .All patients received the same conventional treatment .The patients in the control group （20 cases） inhaled 0.45% saline （10 mL） as placebo; the patients in the heparin group （26 cases） inhaled ordinary heparin （12 500 IU ＆#215;4）;both groups were single aerosol inhalation . Arterial blood analysis and coagulation function were detected in different timing .Results Compared with the control group , in the heparin group , the arterial blood gas indices of PaO 2 , PaO2/FiO2 , SaO2 with the extension of time were gradually increased （P＆lt;0.05）.And compared with before atomizated inhalation heparin, PaO2, PaO2/FiO2, SaO2 were gradually increased in 3, 5, 7 days （P＆lt;0.05）. There was no significant difference of the arterial carbon dioxide tension （ PaCO2 ） before atomization and the first three days in the two groups （P〈0.05）, but PaCO2 began to significantly increased in each group after 5, 7 days （P ＆lt;0.05）.Prothrombin time （PT）, activated partial thromboplastin time （APTT） and fibrinogen （FIB） were not significantly different between the two groups （P〈0.05）. Conclusion Atomizated inhalation o heparin for AECOPD patients by mechanical ventilation is safe and＆amp;nbsp;effective.It can significantly improve arterial partial pressure of oxygen , reduce carbon dioxide partial pressure, but minimal impact the patient＆#39;s coagulation function .