低分子肝素钠辅助治疗慢性阻塞性肺部疾病急性发作合并2型糖尿病

Low Molecular Weight Heparin in Adjuvant Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated with Type 2 Diabetes Mellitus

目的观察低分子肝素辅助治疗慢性阻塞性肺部疾病急性发作（AECOPD）合并2型糖尿病（T2 DM）的临床疗效并对炎性因子和凝血功能的影响。方法入选2012年10月-2014年4月115例AECOPD合并T2 DM患者并据随机数字分为研究组（61例）和对照组（54例）,对照组予常规抗感染、抗炎、解痉、氧疗治疗,研究组联合低分子肝素钠皮下注射,每日2次,连续7 d,比较两组治疗后动脉血气指标、炎性因子水平与凝血功能指标。结果 7 d内,研究组改气管切开有创通气比例（29.5%）低于对照组（44.4%）（χ^2=2.756 P=0.097）。对照组有2例（3.8%）并发急性肺栓塞死亡,研究组无死亡病例。研究组治疗7 d后Pa O2（81.0±7.9）mm Hg、Pa CO2（41.5±5.2）mm Hg数值明显优于对照组[（77.8±7.5）mm Hg、（44.0±5.5）mm Hg],差异有统计学意义（P〈0.05）。研究组治疗7 d后aPTT（38.2±5.9）s显著高于对照组（35.9±5.2）s,D二聚体水平（185.8±42.3）μg/L显著低于对照组（204.4±45.7）μg/L,差异有统计学意义（P〈0.05）。研究组治疗7 d后IL-8（32.7±13.1）pg/ml、TNFα（97.9±18.4）pg/ml、CRP（43.3±14.8）mg/L数值均显著低于对照组[（39.4±14.2）pg/ml、（105.2±20.1）pg/ml、（50.2±17.1）mg/L],差异有统计学意义（P〈0.05）。结论 AECDPD合并T2 DM患者在常规治疗基础上联合皮下注射低分子肝素钠,能有效改善机体高凝状态,降低机体炎性反应水平,提高肺部氧合功能,降低病死率。

Objective To observe efficacy of low molecular weight heparin（ LMWH） in adjuvant treatment of AECOPD complicated with T2 DM and its influence on blood coagulation function and inflammatory factors. Methods 115 patients of Oct. 2012-Apr. 2014 were selected and were randomized into study group（ 61 cases） and control group（ 54 cases） according to random number,the control group was given conventional therapy,such as anti infection,anti-inflammatory,spasmolysis,oxygen therapy,et al,the study group was added with LMWH subcutaneous injection,bid,continuously for 7 d,after which arterial blood gas indices,inflammatory factors and coagulation indices of 2 groups were compared. Results Within 7 d,study group with invasive ventilation ratio（ 29. 5%） was higher than control group（ 44. 4%）（ χ^2= 2. 756 P = 0. 097）. The control group had 2 cases（ 3. 8%） die of acute pulmonary embolism,study group with no death case. The study group after 7d treatment whose value of Pa O2（ 81 ± 7. 9） mm Hg,Pa CO2（ 41. 5 ± 5. 2） mm Hg were significantly better than control group[（ 77. 8 ± 7. 5） mm Hg,（ 44 ± 5. 5） mm Hg],the differences were statistically significant（ P〈0.05）. The study group after 7 d treatment whose aPTT（ 38. 2 ± 5. 9） s was significantly higher than control group（ 35. 9 ± 5. 2） s,D-dimer level（ 185. 8 ＋ 42. 3） g / L was significantly lower than control group（ 204. 4 ±45. 7） g / L,the difference were statistically significant（ P〈0. 05）. The study group after treatment whose IL-8（ 32. 7 ± 13. 1） pg /ml,TNFα（ 97. 9 ± 18. 4） pg /ml,CRP（ 43. 3 ＋ 14. 8） mg /Lwere significantly lower than control group[（ 39. 4 ± 14. 2） pg / ml,（ 105. 2 ＋ 20. 1） pg / ml,（ 50. 2 ± 17. 1） mg / L],the differences were statistically significant（ P〈0. 05）. Conclusion Based on conventional treatment,AECOPD patients complicated with T2 DM added with subcutaneous injection of LMWH can effectively reduce hypercoagulable state and inflammatory reaction,improve pulmonary oxygenation function,and then reduce the mortality rate.