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目的观察低分子肝素治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发肺源性心脏病(肺心病)的临床疗效。方法选取2014年1月—2015年3月上海市同仁医院收治的AECOPD并发肺心病患者78例,根据治疗方法分为对照组和观察组,各39例。两组患者入院后均给予常规治疗,观察组患者在此基础上皮下注射低分子肝素钠。比较两组患者治疗前后血流动力学指标、肺功能指标及血气指标。结果两组患者治疗前红细胞比容、全血高切黏度、全血低切黏度、血浆黏度以及纤维蛋白原比较,差异均无统计学意义(P>0.05);观察组患者治疗后红细胞比容、全血高切黏度、全血低切黏度、血浆黏度以及纤维蛋白原均低于对照组(P<0.05)。两组患者治疗前第一秒用力呼气容积(FEV1)、FEV1/用力肺活量(FEV1/FVC)比较,差异均无统计学意义(P>0.05);观察组患者治疗后FEV1、FEV1/FVC均高于对照组(P<0.05)。两组患者治疗前动脉血氧分压(Pa O2)、动脉血氧饱和度(Sa O2)、动脉血二氧化碳分压(Pa CO2)比较,差异均无统计学意义(P>0.05);观察组患者治疗后Pa O2、Sa O2高于对照组,Pa CO2低于对照组(P<0.05)。结论低分子肝素能有效改善AECOPD并发肺心病患者血液高黏、高凝状态,防止或抑制血栓形成,改善血液循环、缺氧和二氧化碳潴留,增加细胞供氧,提高肺功能,最终改善肺循环、心肺功能及预后。
Objective To observe the clinical effect of low molecular weight heparin in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary heart disease (pulmonary heart disease). Methods From January 2014 to March 2015, 78 patients with AECOPD complicated with pulmonary heart disease in Shanghai Tongren Hospital were selected and divided into control group and observation group according to the treatment method, 39 cases in each group. Two groups of patients were given conventional treatment after admission, the observation group patients on the basis of subcutaneous injection of low molecular weight heparin. The hemodynamic indexes, pulmonary function indexes and blood gas indexes before and after treatment were compared between the two groups. Results There was no significant difference in hematocrit, whole blood high shear viscosity, whole blood low shear viscosity, plasma viscosity and fibrinogen before treatment in both groups (P> 0.05). After treatment, the hematocrit , Whole blood high shear viscosity, whole blood low shear viscosity, plasma viscosity and fibrinogen were lower than the control group (P <0.05). The FEV1 and FEV1 / FVC of the two groups before treatment did not show any significant difference (P> 0.05). The FEV1 and FEV1 / FVC Higher than the control group (P <0.05). The PaO2, Sa O2, PaCO 2 of two groups before treatment did not show statistical significance (P> 0.05). The observation group PaO2 and SaO2 in patients after treatment were higher than those in control group, Pa CO2 was lower than that in control group (P <0.05). Conclusion Low molecular weight heparin can effectively improve the high viscosity and hypercoagulable state in patients with AECOPD complicated with pulmonary heart disease, prevent or inhibit thrombus formation, improve blood circulation, hypoxia and carbon dioxide retention, increase oxygen supply to cells, improve lung function and finally improve pulmonary circulation, cardiopulmonary Function and prognosis.