不同剂量低分子肝素钙治疗急性加重期慢性阻塞性肺疾病伴呼吸衰竭患者的临床效果比较

Comparison of clinical effect of different doses of low molecular weight heparin calcium in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

目的比较不同剂量低分子肝素钙治疗急性加重期慢性阻塞性肺疾病(AECOPD)伴呼吸衰竭患者的临床效果。方法将2018年1月至2020年8月在我院就诊的60例AECOPD伴呼吸衰竭患者按照随机数字表法分为A、B、C三组,各20例。A组给予小剂量低分子肝素钙,B组给予中剂量低分子肝素钙,C组给予大剂量低分子肝素钙。比较三组的临床疗效、凝血功能指标、血液流变学指标、肺通气功能指标、动脉血气指标、出血事件发生情况。结果三组的治疗总有效率无显著差异(P>0.05)。治疗后,三组的TT、PT、APTT从长至短依次为C、B、A组(P<0.05)。治疗后,三组的全血高切黏度、全血低切黏度、血浆黏度从高至低依次为A、B、C组(P<0.05)。治疗后,三组的FEV_(1)、FEV_(1)/FVC、PaO_(2)从高至低依次为C、B、A组,PaCO_(2)从高至低依次为A、B、C组(P<0.05)。C组的出血事件总发生率显著高于A、B组(P<0.05),而A组与B组的出血事件总发生率无显著差异(P>0.05)。结论采用中剂量低分子肝素钙治疗AECOPD伴呼吸衰竭患者,既可有效改善患者的肺通气功能、动脉血气、凝血功能、血液流变学指标,又可降低出血风险,兼具有效性和安全性。

Objective To compare the clinical effect of different doses of low molecular weight heparin calcium in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with respiratory failure.Methods From January 2018 to August 2020,60 AECOPD patients with respiratory failure treated in our hospital were divided into A,B,C three groups according to random number table method,with 20 cases in each group.The group A was given low-dose low molecular weight heparin calcium,the group B was given medium-dose low molecular weight heparin calcium,and the group C was given high-dose low molecular weight heparin calcium.The clinical efficacy,coagulation function indexes,hemorheology indexes,pulmonary ventilation function indexes,arterial blood gas indexes and occurrence of bleeding events were compared among the three groups.Results There was no significant difference in the total effective rate of treatment among the three groups(P>0.05).After treatment,TT,PT and APTT of the three groups from long to short were the group C,B and A(P<0.05).After treatment,whole blood high shear viscosity,whole blood low shear viscosity and plasma viscosity of the three groups from high to low were the group A,B and C(P<0.05).After treatment,FEV_(1),FEV_(1)/FVC and PaO_(2) of the three groups from high to low were the group C,B and A,PaCO_(2) from high to low was the group A,B and C(P<0.05).The total incidence of bleeding events in the group C were significantly higher than that in the group A and the group B(P<0.05),but there was no significant difference in the total incidence of bleeding events between the group A and the group B(P>0.05).Conclusion The medium-dose low molecular weight heparin calcium in the treatment of AECOPD patients with respiratory failure can not only effectively improve the pulmonary ventilation function,arterial blood gas,coagulation function and hemorheological indexes of patients,but also reduce the risk of bleeding,with both effectiveness and safety.