低分子肝素对慢性阻塞性肺疾病急性加重合并继发性红细胞增多症患者的疗效观察

Clinical Effect on Patients with AECOPD complicated with Secondary Polycythemia by Low Molecular Weight Heparin

目的:探讨低分子肝素对慢性阻塞性肺疾病急性加重(AECOPD)合并继发性红细胞增多症患者的临床疗效及其安全性。方法:选择AECOPD合并继发性红细胞增多患者119例,分为常规组64例和低分子肝素组55例。常规组给予常规治疗措施,低分子肝素组在常规治疗基础上加用低分子肝素。比较两组治疗前、治疗7d后改良版英国医学研究会呼吸困难评定量表(mMRC评分)、血红蛋白、D-二聚体、血气分析及肺功能变化情况。结果:两组治疗后mMRC评分、PaO_2、PaCO_2、FEV_1%、FEV_1/FVC均较治疗前有明显改善(P<0.05),但低分子肝素组改善更明显(P<0.05)。常规组治疗前、后D-二聚体下降差异无统计学意义(P>0.05),而低分子肝素组下降差异有统计学意义(P<0.05)。两组治疗前、后血红蛋白下降差异无统计学意义(P>0.05)。低分子肝素治疗期间无不良反应发生。结论:低分子肝素能有效改善AECOPD合并继发性红细胞增多症的呼吸困难、低氧血症、二氧化碳潴留和肺功能及降低肺栓塞发生,值得临床推广。

Objective:To investigate the clinical effect of patients with AECOPD complicated with secondary polycythemia by low molecular weight heparin(LMWH) and its safety.Methods:119 patients with AECOPD complicated with secondary polycythemia were divided into routine group(n=64) and LMWH group(n=55).Routine group were treated with conventional treatment method,LMWH group were treated with LMWH on basis of routine group. mMRC dyspnea scale, hemoglobin,D-dimer,arterial blood gas indexes(PaO2 and PaCO2), lung function index(FEV1% and FEV1/FVC) were compared between two groups.Results:The mMRC score,PaO2,PaCO2,FEV1%,FEV1/FVC levels after treatment were significantly improvement in each group, but those in LMWH group improved more obviously(P<0.05). The level of D-dimer was significantly reduced in LMWH group before and after treatment(P<0.05),but there was no difference in routine group(P>0.05).The levels of hemoglobin were reduced in the two groups,but there was no differences between both groups(P>0.05).There was no obvious adverse reactions occur in LMWH group.Conclusion:LMWH can effectively improve degree of dyspnea,level of D-dimer,arterial blood gas indexes and lung function, which is meaningful to prevent pulmonary embolism,worthy of promotion for AECOPD complicated with secondary polycythemia.