低分子肝素治疗老年慢性阻塞性肺疾病急性加重期患者的效果观察
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摘要
目的探讨应用低分子肝素对老年慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效及相关指标的影响。方法选取106例老年AECOPD患者,分为对照组52例和观察组54例。对照组采用常规治疗,观察组在对照组基础上采用低分子肝素治疗,维持治疗10d。观察两组患者临床疗效及二氧化碳分压(PaCO_2)、氧分压(Pa O_2)、一秒用力呼气容积/用力肺活量(FEV1/FVC)、第1秒用力呼气容积占预计值百分比(FEV1%pred)、血纤维蛋白原(Fbg)、高敏C反应蛋白(hs-CRP)和肿瘤坏死因子-α(TNF-α)的变化。结果治疗后,观察组患者的总有效率高于对照组(P<0.05)。两组患者治疗前各指标差异均无统计学意义(P均>0.05)。两组患者治疗后Pa O_2、FEV1/FVC、FEV1%pred水平均高于治疗前,PaCO_2、Fbg、hs-CRP、TNF-α水平均低于治疗前(P均<0.01)。观察组患者治疗后PaO_2、FEV1/FVC和FEV1%pred水平高于对照组,PaCO_2、Fbg、hs-CRP、TNF-α水平均低于对照组(P均<0.01)。结论应用低分子肝素治疗老年AECOPD患者疗效较好,可有效改善患者血气分析和肺功能,改善血液高凝状态,降低炎症反应,且无不良反应发生。
Objective To explore the effect of low molecular weight heparin on clinical efficacy and related indicators of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods 106 elderly patients with AECOPD were divided into control group(52 cases) and observation group(54 cases). The control group was treated with conventional therapy,and the observation group was treated with LMWH on the basis of the control group for 10 days. The clinical efficacy and changes of partial pressure of carbon dioxide(Pa CO_2),partial pressure of oxygen(Pa O_2),forced expiratory volume per second(FEV1/FVC),forced expiratory volume per second(FEV1% pred),fibrinogen(Fbg),high sensitive C-reactive protein(hs-CRP) and tumor necrosis factor-α(TNF-α)were observed. Results After treatment,the total effective rate of the observation group was higher than that of the control group(P<0.05). There was no significant difference in each index between the two groups before treatment(P>0.05). After treatment,the levels of Pa O_2,FEV1/FVC and FEV1% PRED in both groups were higher than those before treatment,while the levels of Pa CO_2,Fbg,hs-CRP and TNF-α were lower than those before treatment(all P<0.01). After treatment,the levels of Pa O_2,FEV1/FVC and FEV1% PRED in the observation group were higher than those in the control group,while the levels of Pa CO_2,Fbg,hs-CRP and TNF-α in the observation group were lower than those in the control group(all P<0.01). Conclusion Low molecular weight heparin is effective in the treatment of elderly patients with AECOPD. It can effectively improve blood gas analysis and lung function,improve blood hypercoagulability,reduce inflammation and no adverse reactions.
Objective To explore the effect of low molecular weight heparin on clinical efficacy and related indicators of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods 106 elderly patients with AECOPD were divided into control group(52 cases) and observation group(54 cases). The control group was treated with conventional therapy,and the observation group was treated with LMWH on the basis of the control group for 10 days. The clinical efficacy and changes of partial pressure of carbon dioxide(Pa CO_2),partial pressure of oxygen(Pa O_2),forced expiratory volume per second(FEV1/FVC),forced expiratory volume per second(FEV1% pred),fibrinogen(Fbg),high sensitive C-reactive protein(hs-CRP) and tumor necrosis factor-α(TNF-α)were observed. Results After treatment,the total effective rate of the observation group was higher than that of the control group(P<0.05). There was no significant difference in each index between the two groups before treatment(P>0.05). After treatment,the levels of Pa O_2,FEV1/FVC and FEV1% PRED in both groups were higher than those before treatment,while the levels of Pa CO_2,Fbg,hs-CRP and TNF-α were lower than those before treatment(all P<0.01). After treatment,the levels of Pa O_2,FEV1/FVC and FEV1% PRED in the observation group were higher than those in the control group,while the levels of Pa CO_2,Fbg,hs-CRP and TNF-α in the observation group were lower than those in the control group(all P<0.01). Conclusion Low molecular weight heparin is effective in the treatment of elderly patients with AECOPD. It can effectively improve blood gas analysis and lung function,improve blood hypercoagulability,reduce inflammation and no adverse reactions.
引文
[1]李艳.慢性阻塞性肺病急性加重与凝血功能异常的相性研究[J].四川医学,2013,34(9):1428-1430.
[2]刘章,姬胜利,王凤山.低分子肝素的药理作用和临床应用研究进展[J].药物生物技术,2014,21(6):573-578.
[3]李慧,罗英琳,李朝锋,等.低分子肝素对慢阻肺呼吸衰竭患者微循环及氧代谢状态的影响观察[J].川北医学院学报,2015,30(1):105-108.
[4]吕丽丽,朱述阳,姚红卫,等.重度慢性阻塞性肺疾病急性加重期抗凝干预疗效观察[J].临床肺科杂志,2007,12(11):1176-1177.
[5]卢红,伊燕.低分子肝素治疗老年慢性阻塞性肺疾病合并肺心病急性发作期的效果探讨[J].系统医学,2016,1(3):23-25,31.
[6]刘富新,艾艳红,郝爱军.慢性阻塞性肺病急性加重期血生化指标观察分析[J].现代诊断与治疗,2015,26(16):3718-3719.
[7]葛琴.慢性阻塞性肺病急性加重期高凝状态检测的意义[J].临床肺科杂志,2011,16(10):1560-1561.
[8]卢发勇,唐荣玲,陈俊杰.慢性阻塞性肺疾病急性加重期患者血浆D-二聚体和纤维蛋白原水平变化及其在预后中的意义[J].疑难病杂志,2013,12(6):458-459.
[9]张园满,陈淮林,张淳俊,等.慢性阻塞性肺疾病急性加重期患者PCT和hs-CRP的水平变化及其诊断价值研究[J].中国当代医药,2016,23(21):127-129.
[10]潘继承,朱建一,史恒川,等.血清TNF-α、hs-CRP和PA检测在老年慢性阻塞性肺疾病中的临床价值[J].实用老年医学,2012,26(4):293-295.
[11]罗俊永,崔慧斐.低分子肝素的抗炎作用及机制[J].生命的化学,2008,28(6):727-730.
[12]陈子伟,李耀邦,庄俊合,等.低分子肝素对慢性阻塞性肺疾病急性加重期疗效初探[J].广州医科大学学报,2015,43(1):67-69.
[2]刘章,姬胜利,王凤山.低分子肝素的药理作用和临床应用研究进展[J].药物生物技术,2014,21(6):573-578.
[3]李慧,罗英琳,李朝锋,等.低分子肝素对慢阻肺呼吸衰竭患者微循环及氧代谢状态的影响观察[J].川北医学院学报,2015,30(1):105-108.
[4]吕丽丽,朱述阳,姚红卫,等.重度慢性阻塞性肺疾病急性加重期抗凝干预疗效观察[J].临床肺科杂志,2007,12(11):1176-1177.
[5]卢红,伊燕.低分子肝素治疗老年慢性阻塞性肺疾病合并肺心病急性发作期的效果探讨[J].系统医学,2016,1(3):23-25,31.
[6]刘富新,艾艳红,郝爱军.慢性阻塞性肺病急性加重期血生化指标观察分析[J].现代诊断与治疗,2015,26(16):3718-3719.
[7]葛琴.慢性阻塞性肺病急性加重期高凝状态检测的意义[J].临床肺科杂志,2011,16(10):1560-1561.
[8]卢发勇,唐荣玲,陈俊杰.慢性阻塞性肺疾病急性加重期患者血浆D-二聚体和纤维蛋白原水平变化及其在预后中的意义[J].疑难病杂志,2013,12(6):458-459.
[9]张园满,陈淮林,张淳俊,等.慢性阻塞性肺疾病急性加重期患者PCT和hs-CRP的水平变化及其诊断价值研究[J].中国当代医药,2016,23(21):127-129.
[10]潘继承,朱建一,史恒川,等.血清TNF-α、hs-CRP和PA检测在老年慢性阻塞性肺疾病中的临床价值[J].实用老年医学,2012,26(4):293-295.
[11]罗俊永,崔慧斐.低分子肝素的抗炎作用及机制[J].生命的化学,2008,28(6):727-730.
[12]陈子伟,李耀邦,庄俊合,等.低分子肝素对慢性阻塞性肺疾病急性加重期疗效初探[J].广州医科大学学报,2015,43(1):67-69.