Efficacy Of Low Molecular Weight Heparin In Improving Acute Exacerbation Of COPD Coagulation Function

Objective: To observe the improvement of low molecular weight heparin inpatients with acute exacerbation of COPD coagulation dysfunction effect, in order toclarify its clinical significance in the treatment of acute exacerbation of COPD, andprovide clinical doctors with new methods and theoretical basis in the treatment ofCOPD.Methods: Choose60patients with acute aggravating period of COPD from thecases who see a doctor to our respiratory in January2012to December2012.All thepatients were in accordance with the diagnosis and treatment of chronic obstructivepulmonary disease diagnosis guide (2011edition) criteria for the diagnosis of COPDwhich the Chinese medical association issued. At the same time, the patients with thecases that may cause disease with coagulant function abnormality such as recent bleeding,application of hormone and a serious disease of liver and kidney disease, high bloodpressure, blood system, etc need be excluded. The60(37cases of male and female23)patients with acute aggravating period of COPD were divided into two groups randomly,namely, the experimental group and control group. There is no difference between thetwo groups of patients in gender, age, arterial blood gas and blood coagulationdysfunction and etc (P <0.05). The patients in the two groups was gived low flowoxygen therapy and anti-infection, expectorant, cough, spasmolysis and asthma, correctelectrolyte disorders, nutritional support, and when it is necessary to give glucocorticoidand symptomatic treatment such as mechanical ventilation at the same time.The patientsof the experimental group was combined with the low molecular heparin whichtradename is Ke Sai being Produced by sanofi production (Beijing) pharmaceutical co.,LTD.And the usage of the low molecular heparin is4000iu subcutaneous injection, qd, application7days. The changes of the value such as coagulation series(PT, APTT, TT,FIB), D-dimer and arterial blood gas (PaCO2, PaO2) On admission and after treatmentwas Observed.Results:1.We selected the statistics of patients (60cases) of acute exacerbation of COPDwith coagulation series abnormalities which means that the statistics is below and (or)above the lower limit on laboratory reference: PT <11seconds,24cases(40.0%); APTT<31seconds18cases (30%); TT <16seconds,28cases (46.7%); FIB>400mg/dl grams,37cases,(61.7%); D-D>1.3ug/ml,40patients (66.6%).The arterial blood gas analysis ofacute exacerbation of COPD (60cases) was stated,and pH <7.35,46cases(76.6%); PaO2<80mmHg,57cases(95%); PaCO2>45mmHg,34patients (56.6%).2The datas show that the FIB of60patients of COPD with acute exacerbation wassignificantly negatively correlated with PaO2(r=-0.311, P <0.05), and the FIB had asignificant positive correlation with PaCO2(r=0.550, P <0.01); D-dimer wassignificantly negatively correlated with PaO2(r=-0.325, P <0.01),however,it had asignificantly positive correlation with PaCO2(r=0.577, P <0.01).3. The PT, APTT, TT of coagulation series of experimental groups which wastreated by the addition of low molecular weight heparin prolonged,and the difference wasstatistically significant (P <0.05),.FIB and D-dimer decreased significantly (P <0.01),theoxygen partial pressure(PaO2) significantly increased(P <0.01),and carbon dioxide partialpressure (PaCO2) decreased significantly (P <0.01). However,in the control group withconventional therapy,the oxygen partial pressure(PaO2) significantly increased(P<0.01),carbon dioxide partial pressure (PaCO2) decreased significantly (P <0.01).The PT,TT, APTT of coagulation series of experimental groups which was treated by the additionof low molecular weight heparin prolonged,and the difference was not statisticallysignificant (P＞0.05).FIB had statistially significant differences with priortreatment(P<0.05),however the difference of D-dimer was statistically insignificant (P＞ 0.05).4. The coagulation series (PT, APTT, TT, FIB) and D-dimer of experimental andcontrol group had statistically significant differences (P<0.01),and the partial pressure ofoxygen (PaO2) and carbon dioxide partial pressure (PaCO2) showed significantdifference (P <0.01).Conclusion:1. LMWH may reduce FIB and D-dimer levels of plasm significantly..2. LMWH may prolong the time of PT, APTT and TT effectively.3. FIB and D-dimer were significantly negatively correlated. with PaO2.4. FIB and D-dimer showed a significant positive correlation with PaCO2...