低分子肝素对机械通气慢性阻塞性肺病急性加重患者血清P-选择素的影响

Effect of low molecular weight heparin calcium on the expression of P-selectin in the patients with acute exacerba-tion of chronic obstructive pulmonary disease in the state of mechanical ventilation

目的探讨低分子肝素对重症慢性阻塞性肺病急性加重(AECOPD)后血栓前状态的影响。方法将本院2011年9月至2012年9月急诊ICU收治的38例重症AECOPD患者随机分为2组,常规治疗组16例给予常规治疗,低分子肝素组22例在常规治疗的基础上加用低分子肝素钙100 U/kg微泵静脉注射24 h维持,疗程7 d。测定其入院第1天、第7天的P-选择素、D-二聚体(D-dimer,DD)水平,以及血气分析、有创通气时间和APACHEⅡ评分等。结果治疗后低分子肝素组DD、P-选择素水平显著低于常规治疗组(P<0.05),且动脉血氧分压高于常规治疗组(P<0.05),动脉血二氧化碳分压低于常规治疗组(P<0.05)。低分子肝素组较常规治疗组APACHEEⅡ评分改善(P<0.05),有创机械通气时间缩短(P<0.05)。结论老年AECOPD患者予以低分子肝素钙抗凝治疗可显著提高患者疗效。

Objective To investigate the effect of low molecular weight heparin calcium on the prethrombotic state(PTS) in the patients with severe acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Thirty-eight patients with AECOPD were randomly divided into two groups.Sixteen patients were treated with conventional therapy(conventional therapy group).Based on conventional therapy,twenty-two patients were treated with low molecular weight heparin calcium 100 U/kg by 24 h intravenous pumping for 7 d(LMWH group).The levels of D-dimer(DD),P-se-lectin,and arterial blood gas were detected.The invasive ventilation time and APACHE Ⅱ score were recorded.Results Compared with conventional therapy group,the levels of DD and P-selectin significantly decreased after treatment in LM-WH group(P < 0.05).There was significant difference in PaO 2 and PaCO 2 between two groups after therapy(P < 0.05).Compared with conventional therapy group,the APACHEEⅡ score was improved(P < 0.05) and the time of invasive me-chanical ventilation was shortened(P < 0.05).Conclusions The elderly patients with AECOPD receiving low molecu-lar weight heparin for anticoagulant therapy can significantly improve the patients' outcomes.