早期抗凝治疗慢性阻塞性肺疾病的临床疗效观察

Clinical Effect of Early Anticoagulation Therapy on Chronic Obstructive Pulmonary Disease

目的观察早期抗凝治疗慢性阻塞性肺疾病(COPD)的临床疗效。方法选取2011年1月—2013年5月广州市南沙区第六人民医院收治的COPD患者200例,随机分为对照组与观察组,每组100例。对照组患者入院后均予以低流量吸氧、营养支持治疗及对症处理,在此基础上观察组患者予以早期抗凝治疗;两组患者均连续治疗2周。比较两组患者临床疗效,治疗前后血液流变学指标〔全血黏度低切、全血黏度高切、血浆黏度、血细胞比容〕、右心室心肌壁厚度、肺动脉收缩压(PSAP)、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2),随访1、3年内患者肺源性心脏病发生情况。结果观察组患者临床疗效优于对照组(P<0.05)。治疗前两组患者全血黏度低切、全血黏度高切、血浆黏度、血细胞比容比较,差异无统计学意义(P>0.05);治疗后观察组患者全血黏度低切、全血黏度高切、血浆黏度、血细胞比容低于对照组(P<0.05)。治疗前两组患者右心室心肌壁厚度、PSAP比较,差异无统计学意义(P>0.05);治疗后观察组患者右心室心肌壁厚度小于对照组,PSAP低于对照组(P<0.05)。治疗前两组患者Pa O2、Pa CO2比较,差异无统计学意义(P>0.05);治疗后观察组患者Pa O2高于对照组,Pa CO2低于对照组(P<0.05)。随访1、3年观察组患者肺源性心脏病发生率均低于对照组(P<0.05)。结论早期抗凝治疗COPD的临床疗效确切,可有效降低患者血液黏度,改善患者预后,减少肺源性心脏病的发生。

Objective To observe the clinical effect of early anticoagulation therapy on chronic obstructive pulmonary disease （COPD）. Methods From January 2011 to May 2013, a total of 200 patients with COPD were selected in the Sixth People＇s Hospital of Nansha District, Guangzhou, and they were randomly divided into control group and observation group, each of 100 cases. Patients of control group received low -flow oxygen inhalation, nutritional support and symptomatic treatment, on this basis, patients of observation group received early anticoagulation therapy; both groups continuously treated for 2 weeks. Clinical effect, hemodynamic index （ including low - shear whole blood viscosity, high - shear whole blood viscosity, plasma viscosity and hematokrit）, right ventricular myocardial wall thickness, pulmonary arterial systolic pressure （ PSAP）, PaO2 and PaCO2 before and after treatment were compared between the two groups, and incidence of pulmonary heart disease was observed during the 1 - year, 3 - year follow - up. Results The clinical effect of observation group was statistically significantly better than that of control group （ P 〈 0.05 ）. No statistically significant differences of low - shear whole blood viscosity, high - shear whole blood viscosity, plasma viscosity or hematokri was found between the two groups before treatment （ P 〉 0. 05 ）, while low - shear whole blood viscosity, high - shear whole blood viscosity, plasma viscosity and hematokri of observation group were statistically significantly lower than those of control group after treatment （ P 〈 0. 05 ）. No statistically significant differences of right ventricular myocardial wall thickness or PSAP was found between the two groups before treatment （ P 〉 0. 05 ） ; after treatment, right ventricular myocardial wall thickness of observation group was statistically significantly thinner than that of control group, while PSAP of observation group was statistically significantly lower than that of control group （ P 〈 0. 05 ）. No statistically significant differences of PaO2 or PaCO2 was found between the two groups before treatment （ P 〉 0.05 ） ; after treatment, PaO2 of observation group was statistically significantly higher than that of control group, while PaCO2 of observation group was statistically significantly lower than that of control group （ P 〈0. 05）. During the 1 - year, 3 - year follow - up, the incidence of pulmonary heart disease of observation group was statistically significantly lower than that of control group, respectively （P 〈 0. 05 ）. Conclusion Early anticoagulation therapy has certain clinical effect in treating COPD, can effectively reduce the blood viscosity and the risk of pulmonary heart disease, improve the prognosis.