无创通气联合低分子肝素治疗慢性阻塞性肺疾病急性加重期疗效分析

Analysis of clinical effect of noninvasive mechanical ventilation combined with low molecular weight heparin in the treatment of AECOPD

目的探讨无创通气联合低分子肝素治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床疗效。方法选取2013年2月～2014年5月间住院的符合无创机械通气且愿意接受机械通气的AECOPD患者30例,在常规治疗（氧疗、支气管舒张剂、糖皮质激素等）基础上联合低分子肝素治疗,选取同期住院的AECOPD符合无创机械通气但拒绝接受机械通气的患者30例,仅给予常规治疗措施,两组疗程均为10天,观察治疗前后两组患者的总有效率、平均住院时间、血气分析及血液流变学指标。结果治疗后治疗组总有效率显著优于对照组（P〈0.01）,机械通气时间显著少于对照组（P〈0.01）。治疗后两组PO2均显著升高,PCO2均显著降低（P〈0.01）,治疗组的PO2、PCO2改善程度显著优于对照组（P〈0.01）。治疗后两组血液流变学指标均显著降低（P〈0.01）,治疗组的血液流变学指标改善程度显著优于对照组（P〈0.01）。结论无创通气联合低分子肝素治疗慢性阻塞性肺疾病急性加重期的临床疗效明显,能缩短平均住院时间,改善氧合,改善患者血黏状态。

Objective To investigate the clinical effect of noninvasive mechanical ventilation（ NIV） combined with low molecular weight heparin in the treatment of acute exacerbation of chronic obstructive pulmonary diseases（ AECOPD） patients. Methods 30 cases of AECOPD inpatients from February,2013 to May,2014,who accorded with the NIV criterion and would like to accept mechanical ventilation,were selected as treatment group. They were treated with NIV combined with low molecular weight heparin based on conventional treatment which included oxygen therapy,bronchodilators and glucocorticoids,etc. Meanwhile,30 contemporaneous AECOPD inpatients who accorded with the NIV criterion but did not accept mechanical ventilation were selected as control group,and they were given conventional treatment only. Both groups were treated for 10 days. Then,total effective rate,average hospitalization time,blood gas analysis and hemorheology indexes of the two groups before and after treatments were observed. Results After treatment,the total effective rate of the treatment group was obviously higher than that of the control group（ P〈0. 01）,and the average hospitalization time was shorter than that of the the control group（ P〈0. 01）. PO2 of both groups obviously increased,but PCO2 significantly decreased after treatment（ P〈0. 01）. PO2 and PCO2of the treatment group improved more significantly than those of the control group（ P〈0. 01）. Hemorheology indexes of two groups significantly decreased after treatment（ P〈0. 01）,but that of the treatment group improved more significantly（ P〈0. 01）. Conclusion NIV combined with low molecular weight heparin has positive effect in the treatment of AECOPD. This therapy can shorten average hospitalization time,improve oxygenation and blood viscosity.