低分子肝素钠治疗D-二聚体升高的老年慢性阻塞性肺疾病急性加重疗效分析

Effect of anticoagulant therapy with low-molecular-weight heparin sodium on the patients suffering from eldely AECOPD with elevated D-dimer

目的分析低分子肝素钠治疗在D-二聚体(D-dimer)升高的老年慢性阻塞性肺疾病急性加重(AECOPD)患者的疗效。方法纳入88例D-dimer升高的老年AECOPD患者,按数字表法随机分为试验组和对照组,每组44例。对照组患者予以抗炎、化痰、解痉平喘、吸氧等常规治疗,试验组则在相同常规治疗以外,给予低分子肝素钠皮下注射治疗,两组疗程均为7天。观察比较两组患者D-dimer、凝血功能、动脉血气分析、肺功能指标的差异,并进行统计学分析。结果两组患者在性别、年龄等基线资料的比较差异无显著性(P>0.05)。经治疗,两组患者D-dimer、动脉血氧分压(PaO_2)、二氧化碳分压(PaCO_2)、第一秒用力呼气容积(FEV,)占预计值百分比(FEV_1%)、第一秒用力呼气容积/用力肺活量(FEV/FVC)等指标较治疗前均有改善(P<0.05),且试验组各指标改善明显优于对照组(P<0.05),对照组的纤维蛋白原(FgB)、凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)治疗前后差异无显著性。试验组患者未发现明显的因使用低分子肝素钠而引起的药物不良反应。结论在老年AECOPD患者,给予低分子肝素钠抗凝治疗能显著降低患者体内血浆D-dimer,改善血气分析、凝血状态及呼吸功能,同时具备安全性,值得临床应用推广。

Objective To analyze the therapeutic effect of low-molecular-weight heparin sodium in elderly patients who suffering from acute exacerbation of chronic obstructive pulmonary disease( AECOPD) with elevated D-dimer. Method 88 elderly AECOPD patients with elevated D-dimer were randomly divided into observation group and control group,44 cases in each group. Patients in the control group were given anti-inflammatory, expectorant, antispasmodic, antiasthmatic, oxygen inhalation and other conventional treatment, while patients in the observation group were given low-molecular-weight heparin sodium subcutaneous injection treatment in addition to the same conventional treatment. Both two groups were treated for 7 days. The differences of D-dimer, coagulation function, arterial blood gas analysis and pulmonary function between the two groups were observed and compared. Result There was no significant difference in baseline data of sex and age between the two groups(P>0.05). After treatment, D-dimer, arterial oxygen partial pressure( PaO2), carbon dioxide partial pressure( PaCO2), first second forced expiratory volume(FEV1%) and first second forced expiratory volume/forced vital capacity(FEV1/FVC) of the two groups were all improved( P<0.05), and the indexes of the observation group were obviously improved(P<0.05).There was no significant difference in fibrinogen(FgB), prothrombin time(PT) and partially activated prothrombin time(APTT) in the control group before and after treatment. No obvious adverse drug reactions induced by low-molecular-weight heparin were found in the observation group. Conclusion In elderly patients with AECOPD, low-molecular-weight heparin sodium anticoagulant therapy can significantly reduce D-dimer, improve blood gas analysis, coagulation status and respiratory function, and has safety, which is worthy of clinical application.