利伐沙班和低分子肝素治疗老年慢性阻塞性肺疾病急性加重期的效果观察
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摘要
目的比较利伐沙班和低分子肝素治疗老年慢性阻塞性肺疾病急性加重期(AECOPD)的临床效果。方法选取2017年3月至2018年3月河北医科大学附属哈励逊国际和平医院重症医学科收治的老年AECOPD患者120例,按照随机数字表法分为利伐沙班组和低分子肝素组,各60例。2组均给予抗感染、常规氧疗、改善通气、解痉平喘、止咳化痰、改善心功能、加强营养等常规治疗,低分子肝素组在常规治疗基础上皮下注射低分子肝素钙注射液;利伐沙班组在常规治疗基础上加用利伐沙班片。比较2组患者治疗效果、住院时间、治疗前后血气分析变化,包括p H值、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)及Pa O2/吸入氧浓度(Fi O2)比值。观察2组用药后不良反应发生情况。结果治疗后,利伐沙班组总有效率明显高于低分子肝素组[86. 7%(52/60)比61. 7%(37/60)],差异有统计学意义(P <0. 05)。利伐沙班组平均住院时间明显短于低分子肝素组[(11. 5±1. 4) d比(17. 5±7. 1) d],差异有统计学意义(P <0. 01)。2组治疗前血气分析指标比较差异均无统计学意义(均P> 0. 05)。治疗后,利伐沙班组血气分析指标明显改善,且p H值、Pa O2、Pa O2/Fi O2比值明显高于低分子肝素组[(7. 38±0. 17)比(7. 30±0. 14)、(88±6) mm Hg(1 mm Hg=0. 133 k Pa)比(80±4) mm Hg、(315±16) mm Hg比(240±15) mm Hg],Pa CO2明显低于低分子肝素组[(43. 5±2. 8) mm Hg比(59. 2±6. 2) mm Hg],差异均有统计学意义(均P <0. 05)。利伐沙班组不良反应发生率明显低于低分子肝素组[3. 3%(2/60)比21. 7%(13/60)],差异有统计学意义(P <0. 05)。结论利伐沙班片抗凝治疗对老年AECOPD效果优于低分子肝素钙注射液,能明显缩短住院时间,改善血气分析指标,且不良反应较少。
Objective To analyze the clinical effects of rivaroxaban and low molecular weight heparins( LMWH) on acute exacerbation of chronic obstructive pulmonary disease( AECOPD) in elderly patients.Methods From March 2017 to March 2018,120 elderly patients with AECOPD were enrolled in Harrison International Peace Hospital Affiliated to Hebei Medical University. They were randomly divided into rivaroxaban group and LMWH group,with 60 cases in each group. Both groups had routine treatments including anti-infection,oxygen therapy,ventilation,relieving spasm and asthma,relieving cough and phlegm,improving cardiac function and nutrition. The LMWH group was treated with subcutaneous injection of LMWH and the rivaroxaban group took rivaroxaban tablets on the basis of routine treatments. Therapeutic effect,hospitalization time,blood gas indicators including p H value,arterial oxygen partial pressure( Pa O2),arterial carbon dioxide partial pressure( Pa CO2),Pa O2/inhaled oxygen concentration( Fi O2) and adverse reactions were analyzed. Results The total effective rate in rivaroxaban group was significantly higher than that in LMWH group[86. 7%( 52/60) vs 61. 7%( 37/60) ]( P < 0. 05). The mean hospitalization time in rivaroxaban group was significantly shorter than that in LMWH group[( 11. 5 ± 1. 4) d vs( 17. 5 ± 7. 1) d]( P < 0. 01). There was no significant difference of blood gas indicators between groups before treatment( P > 0. 05). After treatment,p H value,Pa O2 and Pa O2/Fi O2 in rivaroxaban group were significantly higher than those in LMWH group[( 7. 38 ± 0. 17) vs( 7. 30 ± 0. 14),( 88 ± 6) mm Hg vs( 80 ± 4) mm Hg,( 315 ± 16) mm Hg vs( 240 ± 15) mm Hg]; Pa CO2 in rivaroxaban group was significantly lower than that in LMWH group[( 43. 5 ± 2. 8) mm Hg vs( 59. 2 ± 6. 2) mm Hg]( P < 0. 05). The incidence of adverse reactions in rivaroxaban group was significantly lower than that in LMWH group[3. 3%( 2/60) vs 21. 7%( 13/60) ]( P <0. 05). Conclusion Rivaroxaban shows a better anticoagulant effect on AECOPD in elderly patients than LMWH; the advantages include short hospitalization time,optimistic blood gas condition and few adverse reaction.
Objective To analyze the clinical effects of rivaroxaban and low molecular weight heparins( LMWH) on acute exacerbation of chronic obstructive pulmonary disease( AECOPD) in elderly patients.Methods From March 2017 to March 2018,120 elderly patients with AECOPD were enrolled in Harrison International Peace Hospital Affiliated to Hebei Medical University. They were randomly divided into rivaroxaban group and LMWH group,with 60 cases in each group. Both groups had routine treatments including anti-infection,oxygen therapy,ventilation,relieving spasm and asthma,relieving cough and phlegm,improving cardiac function and nutrition. The LMWH group was treated with subcutaneous injection of LMWH and the rivaroxaban group took rivaroxaban tablets on the basis of routine treatments. Therapeutic effect,hospitalization time,blood gas indicators including p H value,arterial oxygen partial pressure( Pa O2),arterial carbon dioxide partial pressure( Pa CO2),Pa O2/inhaled oxygen concentration( Fi O2) and adverse reactions were analyzed. Results The total effective rate in rivaroxaban group was significantly higher than that in LMWH group[86. 7%( 52/60) vs 61. 7%( 37/60) ]( P < 0. 05). The mean hospitalization time in rivaroxaban group was significantly shorter than that in LMWH group[( 11. 5 ± 1. 4) d vs( 17. 5 ± 7. 1) d]( P < 0. 01). There was no significant difference of blood gas indicators between groups before treatment( P > 0. 05). After treatment,p H value,Pa O2 and Pa O2/Fi O2 in rivaroxaban group were significantly higher than those in LMWH group[( 7. 38 ± 0. 17) vs( 7. 30 ± 0. 14),( 88 ± 6) mm Hg vs( 80 ± 4) mm Hg,( 315 ± 16) mm Hg vs( 240 ± 15) mm Hg]; Pa CO2 in rivaroxaban group was significantly lower than that in LMWH group[( 43. 5 ± 2. 8) mm Hg vs( 59. 2 ± 6. 2) mm Hg]( P < 0. 05). The incidence of adverse reactions in rivaroxaban group was significantly lower than that in LMWH group[3. 3%( 2/60) vs 21. 7%( 13/60) ]( P <0. 05). Conclusion Rivaroxaban shows a better anticoagulant effect on AECOPD in elderly patients than LMWH; the advantages include short hospitalization time,optimistic blood gas condition and few adverse reaction.
引文
[1]张谨超,王金荣,刘淑红,等.利伐沙班治疗慢性阻塞性肺疾病急性加重期的效果观察[J].中国医药,2013,8(12):1703-1704. DOI:10. 3760/cma. j. issn. 1673-4777. 2013. 12. 009.Zhang JC,Wang JR,Liu SH,et al. Clinical effect of rivarxocaban in the treatment of acute exacerbation of chronic obstructive pulmonary disease[J]. China Medicine,2013,8(12):1703-1704. DOI:10.3760/cma. j. issn. 1673-4777. 2013. 12. 009.
[2]伍滔.低分子肝素对慢性阻塞性肺疾病急性加重期的临床疗效观察[J].世界临床医学,2017,11(2):2,5.Wu T. Clinical observation of low molecular weight heparin on acute exacerbation of chronic obstructive pulmonary disease[J].The World Clinical Medicine,2017,11(2):2,5.
[3]郑玉兰,王晓兰.低分子肝素钙联合盐酸氨溴索吸入治疗慢性阻塞性肺疾病急性加重期疗效分析[J].中国医药,2009,4(9):663-664. DOI:10. 3760/cma. j. issn. 1673-4777. 2009.09. 010.Zheng YL, Wang XL. Low-molecular-weight heparin calcium combined with mucosolvan in the treatment of acute exalerbation of chronic obstructive pulmonary disease[J]. China Medicine,2009,4(9):663-664. DOI:10. 3760/cma. j. issn. 1673-4777. 2009.09. 010.
[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(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17. DOI:10. 3760/j:issn:1001-0939. 2007.01. 004.Chronic Obstructive Pulmonary Disease Group, Respiratory Medicine Branch of Chinese Medical Association. Guidelines for diagnosis and treatment of chronic obstructive pulmonary disease(revised version 2007)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases,2007,30(1):8-17. DOI:10. 3760/j:issn:1001-0939. 2007. 01. 004.
[5]李雪珍,王清兰.抗凝疗法在改善慢性阻塞性肺疾病中的应用观察[J].中国医药导报,2010,7(34):32-33. DOI:10. 3969/j.issn. 1673-7210. 2010. 34. 015.Li XZ,Wang QL. Clinical observation of anticoagulant therapy in patients with chronic obstructive pulmonary diseases[J]. China Medical Herald,2010,7(34):32-33. DOI:10. 3969/j. issn.1673-7210. 2010. 34. 015.
[6]白澎,陈东宁,孙永昌.慢性阻塞性肺疾病急性加重期C-反应蛋白、D-二聚体与肺动脉高压关系探讨[J].中国现代医学杂志,2009,19(8):1204-1207.Bai P,Chen DN,Sun YC. Relationship between CRP,D-dimer and pulmonary hypertension in patients with AECOPD[J]. China Journal of Modern Medicine,2009,19(8):1204-1207.
[7]王辰,杜敏捷,曹大德,等.慢性肺原性心脏病急性发作期肺细小动脉血栓形成的病理观察[J].中华医学杂志,1997,77(2):123-125.Wang C,Du MJ,Cao DD,et al. A Pathological Study of in situ Thrombosis of Small Pulmonary Arteries and Arterioles in Autopsy Cases of Chronic Cor Pulmonale[J]. National Medical Journal of China,1997,77(2):123-125.
[8]程妮.小剂量低分子肝素钙在治疗慢性阻塞性肺病中的应用探究[J].中国现代药物应用,2015,9(3):87-88. DOI:10.14164/j. cnki. cn11-5581/r. 2015. 03. 064.Cheng N. Application of low dose low molecular weight heparin calcium in the treatment of chronic obstructive pulmonary disease[J].Chinese Journal of Modern Drug Application,2015,9(3):87-88.DOI:10. 14164/j. cnki. cn11-5581/r. 2015. 03. 064.
[9]苏湘珍.小剂量低分子肝素钙在治疗慢性阻塞性肺疾病中的应用探究[J].中国现代药物应用,2015,9(8):93-94. DOI:10. 14164/j. cnki. cn11-5581/r. 2015. 08. 069.Su XZ. Application of low dose low molecular weight heparin calcium in the treatment of chronic obstructive pulmonary disease[J].Chinese Journal of Modern Drug Application,2015,9(8):93-94.DOI:10. 14164/j. cnki. cn11-5581/r. 2015. 08. 069.
[10]王贵勤,刘靖丰.慢性阻塞性肺疾病患者急性加重期血浆D-二聚体与纤维蛋白原浓度变化的临床意义[J].中国医药,2012,7(6):716-718. DOI:10. 3760/cma. j. issn. 1673-4777. 2012.06. 023.Wang GQ,Liu JF. Clinical significance of the concentration changes of plasma D dimer and fibrinogen of patients with chronic obstructive pulmonary disease during acute exaecebation[J]. China Medicine,2012,7(6):716-718. DOI:10. 3760/cma. j. issn. 1673-4777. 2012.06. 023.
[11]齐五松,刘林涛,唐国民.小剂量低分子肝素钙治疗慢性阻塞性肺炎的临床疗效[J].数理医药学杂志,2016,29(1):87-88.DOI:10. 3969/j. issn. 1004-4337. 2016. 01. 048.Qi WS,Liu LT,Tang GM. Clinical efficacy of low dose low molecular weight heparin calcium in the treatment of chronic obstructive pulmonary disease[J]. Journal of Mathematical Medicine,2016,29(1):87-88. DOI:10. 3969/j. issn. 1004-4337. 2016. 01.048.
[12]冯慧萍.低分子肝素对慢性阻塞性肺疾病患者的疗效[J].包头医学院学报,2016,32(5):46-48.Feng HP. Efficacy of low molecular weight heparin in patients with chronic obstructive pulmonary disease[J]. Journal of Baotou Medical College,2016,32(5):46-48.
[13]刘晓,崔一民.新型抗凝血药物———利伐沙班[J].中国药房,2010,21(1):83-86.Liu X,Cui YM. New anticoagulant drugs-rivaroxaban[J]. China Pharmacy,2010,21(1):83-86.
[2]伍滔.低分子肝素对慢性阻塞性肺疾病急性加重期的临床疗效观察[J].世界临床医学,2017,11(2):2,5.Wu T. Clinical observation of low molecular weight heparin on acute exacerbation of chronic obstructive pulmonary disease[J].The World Clinical Medicine,2017,11(2):2,5.
[3]郑玉兰,王晓兰.低分子肝素钙联合盐酸氨溴索吸入治疗慢性阻塞性肺疾病急性加重期疗效分析[J].中国医药,2009,4(9):663-664. DOI:10. 3760/cma. j. issn. 1673-4777. 2009.09. 010.Zheng YL, Wang XL. Low-molecular-weight heparin calcium combined with mucosolvan in the treatment of acute exalerbation of chronic obstructive pulmonary disease[J]. China Medicine,2009,4(9):663-664. DOI:10. 3760/cma. j. issn. 1673-4777. 2009.09. 010.
[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(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17. DOI:10. 3760/j:issn:1001-0939. 2007.01. 004.Chronic Obstructive Pulmonary Disease Group, Respiratory Medicine Branch of Chinese Medical Association. Guidelines for diagnosis and treatment of chronic obstructive pulmonary disease(revised version 2007)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases,2007,30(1):8-17. DOI:10. 3760/j:issn:1001-0939. 2007. 01. 004.
[5]李雪珍,王清兰.抗凝疗法在改善慢性阻塞性肺疾病中的应用观察[J].中国医药导报,2010,7(34):32-33. DOI:10. 3969/j.issn. 1673-7210. 2010. 34. 015.Li XZ,Wang QL. Clinical observation of anticoagulant therapy in patients with chronic obstructive pulmonary diseases[J]. China Medical Herald,2010,7(34):32-33. DOI:10. 3969/j. issn.1673-7210. 2010. 34. 015.
[6]白澎,陈东宁,孙永昌.慢性阻塞性肺疾病急性加重期C-反应蛋白、D-二聚体与肺动脉高压关系探讨[J].中国现代医学杂志,2009,19(8):1204-1207.Bai P,Chen DN,Sun YC. Relationship between CRP,D-dimer and pulmonary hypertension in patients with AECOPD[J]. China Journal of Modern Medicine,2009,19(8):1204-1207.
[7]王辰,杜敏捷,曹大德,等.慢性肺原性心脏病急性发作期肺细小动脉血栓形成的病理观察[J].中华医学杂志,1997,77(2):123-125.Wang C,Du MJ,Cao DD,et al. A Pathological Study of in situ Thrombosis of Small Pulmonary Arteries and Arterioles in Autopsy Cases of Chronic Cor Pulmonale[J]. National Medical Journal of China,1997,77(2):123-125.
[8]程妮.小剂量低分子肝素钙在治疗慢性阻塞性肺病中的应用探究[J].中国现代药物应用,2015,9(3):87-88. DOI:10.14164/j. cnki. cn11-5581/r. 2015. 03. 064.Cheng N. Application of low dose low molecular weight heparin calcium in the treatment of chronic obstructive pulmonary disease[J].Chinese Journal of Modern Drug Application,2015,9(3):87-88.DOI:10. 14164/j. cnki. cn11-5581/r. 2015. 03. 064.
[9]苏湘珍.小剂量低分子肝素钙在治疗慢性阻塞性肺疾病中的应用探究[J].中国现代药物应用,2015,9(8):93-94. DOI:10. 14164/j. cnki. cn11-5581/r. 2015. 08. 069.Su XZ. Application of low dose low molecular weight heparin calcium in the treatment of chronic obstructive pulmonary disease[J].Chinese Journal of Modern Drug Application,2015,9(8):93-94.DOI:10. 14164/j. cnki. cn11-5581/r. 2015. 08. 069.
[10]王贵勤,刘靖丰.慢性阻塞性肺疾病患者急性加重期血浆D-二聚体与纤维蛋白原浓度变化的临床意义[J].中国医药,2012,7(6):716-718. DOI:10. 3760/cma. j. issn. 1673-4777. 2012.06. 023.Wang GQ,Liu JF. Clinical significance of the concentration changes of plasma D dimer and fibrinogen of patients with chronic obstructive pulmonary disease during acute exaecebation[J]. China Medicine,2012,7(6):716-718. DOI:10. 3760/cma. j. issn. 1673-4777. 2012.06. 023.
[11]齐五松,刘林涛,唐国民.小剂量低分子肝素钙治疗慢性阻塞性肺炎的临床疗效[J].数理医药学杂志,2016,29(1):87-88.DOI:10. 3969/j. issn. 1004-4337. 2016. 01. 048.Qi WS,Liu LT,Tang GM. Clinical efficacy of low dose low molecular weight heparin calcium in the treatment of chronic obstructive pulmonary disease[J]. Journal of Mathematical Medicine,2016,29(1):87-88. DOI:10. 3969/j. issn. 1004-4337. 2016. 01.048.
[12]冯慧萍.低分子肝素对慢性阻塞性肺疾病患者的疗效[J].包头医学院学报,2016,32(5):46-48.Feng HP. Efficacy of low molecular weight heparin in patients with chronic obstructive pulmonary disease[J]. Journal of Baotou Medical College,2016,32(5):46-48.
[13]刘晓,崔一民.新型抗凝血药物———利伐沙班[J].中国药房,2010,21(1):83-86.Liu X,Cui YM. New anticoagulant drugs-rivaroxaban[J]. China Pharmacy,2010,21(1):83-86.