Padua评估模型对慢性阻塞性肺疾病患者预防性抗凝治疗的指导作用
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摘要
目的探讨Padua评估模型对慢性阻塞性肺疾病(COPD)患者预防性抗凝治疗中的指导作用。方法收集湛江中心人民医院收治的COPD患者60例,采用Padua评估模型分出低危组27例,高危组33例,比较两组经过1周(1个疗程)的抗凝治疗前后凝血功能[包括凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、D-二聚体、纤维蛋白原(Fbg)以及同型半胱氨酸(Hcy)]、肺通气功能、血气分析指标变化。结果高危组静脉血栓栓塞疾病(VTE)发生率明显高于低危组(P<0.05)。与治疗前相比,治疗后低危组及高危组动脉血氧分压(PO2)、第1秒用力呼气容积占预计值百分比(FEV1%Pred)升高,二氧化碳分压(PCO2)降低,PT、TT、APTT延长,Fbg、Hcy及D-二聚体水平降低(P<0.05)。与低危组相比,高危组D-二聚体及Hcy水平降低幅度更为明显(P<0.05)。所有纳入患者给予抗凝治疗后,均未出现出血风险,安全性较高。结论采用Padua评估模型对COPD患者进行筛选能较好地识别高危VTE患者并指导预防性抗凝治疗。
Objective To explore the guiding role of Padua evaluation model in the preventive anticoagulation therapy for patients with chronic obstructive pulmonary disease(COPD). Methods Totally60 COPD patients in Zhanjiang Central People's Hospital were collected and divided into low-risk group(n=27) and high-risk group(n=33) by using Padua evaluation model. Coagulation function including prothrombin time, thrombin time, activated partial thromboplastin time, D-dimer, fibrinogen and homocysteine(Hcy), and pulmonary ventilation function and blood gas analysis index of the two groups were compared before and after one week anticoagulation treatment(a course of treatment).Results The incidence of venous thromboembolism(VTE) in high-risk group was significantly higher than that in low-risk group. Compared with those before treatment, the arterial partial pressure of oxygen(PO2) and FEV1%Pred increased, the partial pressure of carbon dioxide(PCO2) decreased,the prothrombin time, activated partial thromboplastin time and thrombin time prolonged, and the levels of fibrinogen, Hcy and D-dimer decreased in low-risk group and high-risk group after treatment(P<0.05). Compared with low-risk group, the D-dimer and Hcy levels in high-risk group decreased significantly(P<0.05). No risk of bleeding occurred after anticoagulation treatment, and the safety was high. Conclusion Padua evaluation model can identify high-risk VTE patients and guide preventive anticoagulation therapy for COPD patients.
Objective To explore the guiding role of Padua evaluation model in the preventive anticoagulation therapy for patients with chronic obstructive pulmonary disease(COPD). Methods Totally60 COPD patients in Zhanjiang Central People's Hospital were collected and divided into low-risk group(n=27) and high-risk group(n=33) by using Padua evaluation model. Coagulation function including prothrombin time, thrombin time, activated partial thromboplastin time, D-dimer, fibrinogen and homocysteine(Hcy), and pulmonary ventilation function and blood gas analysis index of the two groups were compared before and after one week anticoagulation treatment(a course of treatment).Results The incidence of venous thromboembolism(VTE) in high-risk group was significantly higher than that in low-risk group. Compared with those before treatment, the arterial partial pressure of oxygen(PO2) and FEV1%Pred increased, the partial pressure of carbon dioxide(PCO2) decreased,the prothrombin time, activated partial thromboplastin time and thrombin time prolonged, and the levels of fibrinogen, Hcy and D-dimer decreased in low-risk group and high-risk group after treatment(P<0.05). Compared with low-risk group, the D-dimer and Hcy levels in high-risk group decreased significantly(P<0.05). No risk of bleeding occurred after anticoagulation treatment, and the safety was high. Conclusion Padua evaluation model can identify high-risk VTE patients and guide preventive anticoagulation therapy for COPD patients.
引文
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[2]刘晓涵,卢根娣.国外静脉血栓栓塞症风险评估工具的研究进展[J].护理学杂志,2014,29(12):94-96.
[3]丁炎明,李晶,刘飞,等.常用静脉血栓栓塞症风险评估工具在临床中的应用[J].中国护理管理,2017,17(11):1451-1457.
[4]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南[J].中华内科杂志,2002,41(8):453-460.
[5]李东繁,杜旭升,刘安.Padua风险评估模型在慢性阻塞性肺疾病急性加重期患者并发静脉血栓栓塞疾病预防中的作用[J].陕西医学杂志,2016,45(11):1509-1510.
[6]《内科住院患者静脉血栓栓塞症预防的中国专家建议》写作组.内科住院患者静脉血栓栓塞症预防的中国专家建议[J].中华老年医学杂志,2015,32(4):3-8.
[7] Le Mao R, Tromeur C, Bazire A, et al. Risk of recur-rent venous thromboembolism in COPD patients:resultsfrom a prospective cohort study[J]. Eur Respir J, 2017,50(1):1700094.
[8]顿晓熠,刘志英,吴勤奋.Padua评分联合D-二聚体在2型糖尿病内科住院患者静脉血栓栓塞症诊断中的价值研究[J].中国全科医学,2017,20(29):3617-3621.