老年人慢性阻塞性肺疾病急性加重期并发呼吸衰竭和多器官功能障碍综合征凝血功能的变化及其临床意义

Investigate the changes and clinical significance of coagulation function of the elderly AECOPD complicated by RF and MODS

目的：探讨分析老年人慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）并发呼吸衰竭（respiratory failure,RF）和多器官功能障碍综合征（multiple organ dysfunction syndrome,MODS）凝血功能的变化及其临床意义。方法选择2014年3月至2015年6月老年人单纯 AECOPD 患者30例（AECOPD 组）,AECOPD 并发 RF 患者26例（RF 组）,AECOPD 并发 MODS 患者19例（MODS 组）,同时选取同期我院体检的健康老年人30名（对照组）,比较各组的血小板、D-二聚体、纤维蛋白原、活化的部分凝血活酶时间、血浆凝血酶原时间、氧分压、二氧化碳分压等肺功能指标差异。结果对照组、AECOPD 组、RF 组、MODS组患者的 D-二聚体、纤维蛋白指标依次上升,差异有统计学意义（P 〈0.05）；对照组、AECOPD组、RF 组、MODS 组患者的氧分压、二氧化碳分压等肺功能指标组间差异有统计学意义（P 〈0.05）；而血小板、活化的部分凝血活酶时间、血浆凝血酶原时间指标在对照组、AECOPD 组、RF组、MODS 组患者中呈上升趋势,但差异无统计学意义（P 〉0.05）。结论老年人 AECOPD 患者处于高凝状态,当合并 RF 和 MODS 时血凝状态加重,值得临床及早重视并采取相关措施以防止病情加剧、恶化。

Objective To investigate the changes and clinical significance of coagulation function of the elderly acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated by respiratory failure（RF）and multiple organ dysfunction syndrome（MODS）.Methods From March 2014 to June 201 5,selecting 30 elderly patients with AECOPD （AECOPD group）,26 elderly patients with AECOPD and RF（RF group）,1 9 elderly patients with AECOPD and MODS（MODS group）,30 healthy elderly people in the same period in our hospital examination（control group）,compare the platelet, D-dimer,fibrinogen,activated partial thromboplastin time,prothrombin time and partial pressure of oxygen,carbon dioxide partial pressure these index difference.Results The D-dimer,fibrin index of control group,AECOPD group,RF group,MODS group patients rose sequentially,the difference was significant（P 〈0.05）;lung function of control group,AECOPD group,RF group,MODS group patients such as partial pressure of oxygen,carbon dioxide was significantly different （P 〈0.05）;and platelets, activated partial thromboplastin time,prothrombin time index of the control group,AECOPD group,RF group,MODS group was rising,which showed no significant difference（P 〉0.05）.Conclusions Elderly patients with AECOPD are in a hypercoagulable state,and when combined with RF and MODS aggravatecoagulation status,worthy of early attention to and take relevant measures to prevent exacerbations, deterioration.