慢性阻塞性肺疾病急性加重期患者应用利伐沙班抗凝临床疗效观察

Observation of the clinical efficacy of rivaroxaban anticoagulant in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(慢阻肺)急性加重期患者应用利伐沙班抗凝治疗对血液高凝状态、肺动脉压及临床症状的影响。方法选取70例于2018年10月至2019年10月在我院呼吸科病房住院治疗的慢阻肺急性加重期患者,按照是否使用利伐沙班,随机分为抗凝组和对照组,各35例。对照组予常规支气管扩张及机械通气等对症治疗,抗凝组在对照组治疗基础上予利伐沙班抗凝治疗。对比两组治疗前、后改良呼吸困难指数(mMRC)、肺功能、肺动脉压、D-二聚体、急性加重次数的改变。结果治疗35 d后,抗凝组与对照组相比,mMRC结果降低(1.9±0.6 vs.1.0±0.5),第一秒用力肺活量(FEV1)/预计值升高(4.36%±4.25%vs.11.32%±7.65%),肺动脉压较前下降[(4.22±6.22)mmHg vs.(11.85±5.41)mmHg],D-二聚体下降[(0.69±0.70)mg/L vs.(1.58±0.66)mg/L],差异有统计学意义(P<0.05)。随访1年,抗凝组急性加重例数较对照组少。结论利伐沙班抗凝治疗对慢阻肺急性加重期患者临床疗效明显,可缓解血液高凝状态,降低肺动脉压,提升肺功能,提高生活质量。

Objective To investigate the effect of rivaroxaban anticoagulant therapy on blood hypercoagulability,pulmonary artery pressure and clinical symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Totally 70 patients with AECOPD in the respiratory ward of our hospital from October 2018 to October 2019 were enrolled.According to whether using rivaroxaban or not,the patients were randomly divided into anticoagulant group and control group,35 cases in each group.The control group received conventional bronchodilator,mechanical ventilation and symptomatic treatment.The anticoagulant group received rivaroxaban anticoagulant therapy on the basis of treatment of control group.The modified MRC dyspnea scale(mMRC),pulmonary function,pulmonary artery pressure,level of D-dimer and the times of exacerbations were compared before and after treatment.Results After 35 days of treatment,compare with the control group,the results of mMRC decreased(1.9±0.6 vs.1.0±0.5),FEV1/pre increased(4.36%±4.25%vs.11.32%±7.65%),the level of D-dimer decreased[(0.69±0.70)mg/L vs.(1.58±0.66)mg/L],and pulmonary artery pressure decreased[(4.22±6.22)mmHg vs.(11.85±5.41)mmHg]in the anticoagulant group.The difference between each group was statistically significant(P<0.05).During the 1-year follow-up,the number of acute exacerbation in anticoagulant group was lower than that in control group.Conclusion Rivaroxaban anticoagulant therapy has obvious clinical efficacy in patients with AECOPD,which can relieve blood hypercoagulability,reduce pulmonary artery pressure,and improve lung function and quality of life.