摘要
目的探讨低分子肝素抗凝治疗在慢性阻塞性肺疾病急性加重(AECOPD)并发呼吸衰竭疑诊急性肺栓塞中的应用价值。方法选择广州市番禺区中医院呼吸内科2016年1月至2018年9月期间收治的80例AECOPD合并呼吸衰竭并疑诊为急性肺栓塞的患者为研究对象,根据随机数表法将患者分为观察组与对照组,每组40例。对照组患者常规给予抗感染及机械通气治疗,观察组在此基础上联合应用低分子肝素抗凝治疗,疗程均为10 d。比较两组患者治疗72 h后的动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、氢离子浓度指数(PH)以及心率(HR)、呼吸频率(RR);同时记录两组患者氧合指数(PaO2/FiO2)恢复正常时间、撤机成功率、呼吸机相关性肺炎(VAP)发生率、病死率以及住ICU时间和并发症发生情况。结果治疗后72 h,观察组患者的HR、RR、PaCO2分别为(80.9±10.4)次/min、(21.2±2.6)次/min、(46.2±7.5)mmHg,明显低于对照组的(112.3±11.3)次/min、(25.2±3.2)次/min、(51.3±9.2)mmHg,PH、PaO2分别为7.32±0.10、(95.1±7.9)mmHg,明显高于对照组的7.24±0.12、(88.6±8.2)mmHg,差异均有统计学意义(P<0.05);观察组患者的PaO2/FiO2恢复正常时间、住ICU时间分别为(2.3±0.5)d、(14.1±3.5)d,均明显短于对照组的(4.2±1.2)d、(17.5±4.1)d,撤机成功率为77.50%,明显高于对照组的52.50%,且VAP发生率为7.50%,明显低于对照组的22.50%,差异均有统计学意义(P<0.05);两组患者病死率比较差异无统计学意义(P>0.05);观察组患者的不良反应发生率为12.50%,与对照组的7.50%比较差异无统计学意义(P>0.05)。结论低分子肝素抗凝治疗COPD急性加重并发呼吸衰竭疑诊急性肺栓塞的患者具有确切的临床疗效,并且具有较好的用药安全性。
Objective To investigate the application value of anticoagulant therapy with low molecular weight heparin in patients with acute exacerbation of COPD complicated with respiratory failure and suspected acute pulmonary embolism.Methods Eighty patients with AECOPD complicated with respiratory failure and suspected pulmonary embolism who were treated in Guangzhou Panyu District Hospital from January 2016 to September 2018 were selected as the study subjects.They were divided into two groups according to the random number table,with 40 patients in each group.The control group was routinely treated with anti-infection and mechanical ventilation.On this basis,the observation group was treated with low molecular weight heparin anticoagulation for 10 days.72 hours after treatment,the arterial partial pressure of oxygen(PaO2),partial pressure of carbon dioxide(PaCO2),hydrogen ion concentration index(PH),heart rate(HR),respiratory rate(RR)were compared between the two groups;at the same time,the recovery time of PaO2/FiO2,the success rate of weaning,and the incidence of ventilator-associated pneumonia(VAP),the mortality rate,the time of ICU stay,and complications were recorded.Results 72 hours after treatment,HR,RR,and PaCO2 in the observation group were(80.9±10.4)times/min,(21.2±2.6)times/min,(46.2±7.5)mmHg,significantly lower than(112.3±11.3)times/min,(25.2±3.2)times/min,(51.3±9.2)mmHg in the control group,while PH and PaO2 in the observation group were 7.32±0.10,(95.1±7.9)mmHg,significantly higher than 7.24±0.12,(88.6±8.2)mmHg in the control group(P<0.05).The recovery time of PaO2/FiO2 and ICU time of the observation group was(2.3±0.5)d,(14.1±3.5)d,significantly shorter than(4.2±1.2)d,(17.5±4.1)d of the control group;the successful rate of weaning was higher in the observation group(77.50%vs 52.50%),and the VAP was lower(7.50%vs 22.50%),with statistically significant difference(P<0.05).There was no significant difference in mortality rate between the two groups(P>0.05).The adverse reactions rate in the obse
作者
罗振军
罗胜
何小宇
LUO Zhen-jun;LUO Sheng;HE Xiao-yu(Department of Respiratory Medicine,Guangzhou Panyu District Hospital,Guangzhou 511400,Guangdong,CHINA)
出处
《海南医学》
CAS
2021年第2期153-156,共4页
Hainan Medical Journal
基金
广东省中医药局科研课题(编号:20200513201628)。
关键词
慢性阻塞性肺疾病
急性加重期
呼吸衰竭
低分子肝素
急性肺栓塞
疗效
Chronic obstructive pulmonary disease
Acute exacerbation
Respiratory failure
Low molecular weight heparin
Acute pulmonary embolism
Clinical efficacy
