2019 年第 4 期 第 14 卷

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

Clinical effects of rivaroxaban and low molecular weight heparin on acute exacerbation of chronic obstructive pulmonary disease in elderly patients

作者：张谨超崔月娥刘娜王亚芳焦亚平崔朝勃

英文作者：

单位：053000河北省衡水市，河北医科大学附属哈励逊国际和平医院重症医学科

英文单位：

关键词：慢性阻塞性肺疾病急性加重期；低分子肝素；利伐沙班

英文关键词：

• 摘要：

• 【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pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)及PaO2/吸入氧浓度(FiO2)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pH值、PaO2、PaO2/FiO2比值明显高于低分子肝素组［（7.38±0.17）比（7.30±0.14）、（88±6）mmHg（1 mmHg=0.133 kPa）比（80±4）mmHg、（315±16）mmHg比（240±15）mmHg］，PaCO2明显低于低分子肝素组［（43.5±2.8）mmHg比（59.2±6.2）mmHg］，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。

• 【Abstract】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 pH value, arterial oxygen partial pressure(PaO2), arterial carbon dioxide partial pressure(PaCO2), PaO2/inhaled oxygen concentration(FiO2) 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, pH value, PaO2 and PaO2/FiO2 in rivaroxaban group were significantly higher than those in LMWH group［（7.38±0.17） vs （7.30±0.14）, （88±6）mmHg vs （80±4）mmHg, （315±16）mmHg vs （240±15）mmHg］; PaCO2 in rivaroxaban group was significantly lower than that in LMWH group［（43.5±2.8）mmHg vs （59.2±6.2）mmHg］(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.