CAJ | 학술논문

目的：通过观察慢性阻塞性肺疾病急性加重期（AECOPD）合并肺动脉高压（PH）患者凝血纤溶指标、动脉血气情况，旨在探讨凝血功能及动脉血气变化在AECOPD合并肺动脉高压诊治中的临床意义及其相关性。方法入选248例AECOPD患者，超声心动图测得肺动脉收缩压（PASP）值，根据PASP分为四组：肺动脉压力正常组（≤30 mmHg）80例、轻度PH组（31～50 mmHg）61例、中度PH组（51～70 mmHg）57例和重度PH组（≥71 mmHg）50例，对所有入选患者进行凝血纤溶指标和动脉血气分析检测。结果 AECOPD合并重度PH组D-二聚体（D-Dimer）、血小板计数（PLT）均高于中度PH组、轻度PH组、肺动脉压力正常组，差异具有统计学意义（P＜0.05）；中度PH组D－Dimer、PLT均高于轻度PH组、肺动脉压力正常组，差异具有统计学意义（P＜0.05）；而D-Dimer、PLT在轻度PH组与肺动脉压力正常组两组间比较，差异无统计学意义（P＞0.05）。重度PH组和中度PH组纤维蛋白原（FIB）和动脉血二氧化碳分压（PaCO2）均高于轻度PH组和肺动脉压力正常组，差异具有统计学意义（P＜0.05）；而FIB和PaCO2在重度PH组与中度PH组两组间、轻度PH组与肺动脉压力正常组两组间比较，差异无统计学意义（P＞0.05）。重度PH组和中度PH组动脉血氧分压（PaO2）均低于轻度PH组和肺动脉压力正常组，差异具有统计学意义（P＜0.05）；而PaO2在重度PH组与中度PH组两组间、轻度PH组与肺动脉压力正常组两组间比较，差异无统计学意义（P＞0.05）。四组间部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）水平与总体均数比较，差异均无显著性（P＞0.05）。D-Dimer、FIB、PLT与 PaCO2均呈正相关；D-Dimer、FIB、PLT 与 PaO2均呈负相关；APTT、PT、TT 与PaCO2、PaO2无相关性。D-Dimer、PaCO2与SPAP均呈正相关；PaO2与SPAP均呈负相关。结论对AECOPD患者尤其AECOPD合并肺动脉高压患者监测FIB、D-Dimer、PLT、PaCO2、PaO2的变化具有重要价值。目的：通過觀察慢性阻塞性肺疾病急性加重期（AECOPD）閤併肺動脈高壓（PH）患者凝血纖溶指標、動脈血氣情況，旨在探討凝血功能及動脈血氣變化在AECOPD閤併肺動脈高壓診治中的臨床意義及其相關性。方法入選248例AECOPD患者，超聲心動圖測得肺動脈收縮壓（PASP）值，根據PASP分為四組：肺動脈壓力正常組（≤30 mmHg）80例、輕度PH組（31～50 mmHg）61例、中度PH組（51～70 mmHg）57例和重度PH組（≥71 mmHg）50例，對所有入選患者進行凝血纖溶指標和動脈血氣分析檢測。結果 AECOPD閤併重度PH組D-二聚體（D-Dimer）、血小闆計數（PLT）均高于中度PH組、輕度PH組、肺動脈壓力正常組，差異具有統計學意義（P＜0.05）；中度PH組D－Dimer、PLT均高于輕度PH組、肺動脈壓力正常組，差異具有統計學意義（P＜0.05）；而D-Dimer、PLT在輕度PH組與肺動脈壓力正常組兩組間比較，差異無統計學意義（P＞0.05）。重度PH組和中度PH組纖維蛋白原（FIB）和動脈血二氧化碳分壓（PaCO2）均高于輕度PH組和肺動脈壓力正常組，差異具有統計學意義（P＜0.05）；而FIB和PaCO2在重度PH組與中度PH組兩組間、輕度PH組與肺動脈壓力正常組兩組間比較，差異無統計學意義（P＞0.05）。重度PH組和中度PH組動脈血氧分壓（PaO2）均低于輕度PH組和肺動脈壓力正常組，差異具有統計學意義（P＜0.05）；而PaO2在重度PH組與中度PH組兩組間、輕度PH組與肺動脈壓力正常組兩組間比較，差異無統計學意義（P＞0.05）。四組間部分凝血活酶時間（APTT）、凝血酶原時間（PT）、凝血酶時間（TT）水平與總體均數比較，差異均無顯著性（P＞0.05）。D-Dimer、FIB、PLT與 PaCO2均呈正相關；D-Dimer、FIB、PLT 與 PaO2均呈負相關；APTT、PT、TT 與PaCO2、PaO2無相關性。D-Dimer、PaCO2與SPAP均呈正相關；PaO2與SPAP均呈負相關。結論對AECOPD患者尤其AECOPD閤併肺動脈高壓患者鑑測FIB、D-Dimer、PLT、PaCO2、PaO2的變化具有重要價值。
목적：통과관찰만성조새성폐질병급성가중기（AECOPD）합병폐동맥고압（PH）환자응혈섬용지표、동맥혈기정황，지재탐토응혈공능급동맥혈기변화재AECOPD합병폐동맥고압진치중적림상의의급기상관성。방법입선248례AECOPD환자，초성심동도측득폐동맥수축압（PASP）치，근거PASP분위사조：폐동맥압력정상조（≤30 mmHg）80례、경도PH조（31～50 mmHg）61례、중도PH조（51～70 mmHg）57례화중도PH조（≥71 mmHg）50례，대소유입선환자진행응혈섬용지표화동맥혈기분석검측。결과 AECOPD합병중도PH조D-이취체（D-Dimer）、혈소판계수（PLT）균고우중도PH조、경도PH조、폐동맥압력정상조，차이구유통계학의의（P＜0.05）；중도PH조D－Dimer、PLT균고우경도PH조、폐동맥압력정상조，차이구유통계학의의（P＜0.05）；이D-Dimer、PLT재경도PH조여폐동맥압력정상조량조간비교，차이무통계학의의（P＞0.05）。중도PH조화중도PH조섬유단백원（FIB）화동맥혈이양화탄분압（PaCO2）균고우경도PH조화폐동맥압력정상조，차이구유통계학의의（P＜0.05）；이FIB화PaCO2재중도PH조여중도PH조량조간、경도PH조여폐동맥압력정상조량조간비교，차이무통계학의의（P＞0.05）。중도PH조화중도PH조동맥혈양분압（PaO2）균저우경도PH조화폐동맥압력정상조，차이구유통계학의의（P＜0.05）；이PaO2재중도PH조여중도PH조량조간、경도PH조여폐동맥압력정상조량조간비교，차이무통계학의의（P＞0.05）。사조간부분응혈활매시간（APTT）、응혈매원시간（PT）、응혈매시간（TT）수평여총체균수비교，차이균무현저성（P＞0.05）。D-Dimer、FIB、PLT여 PaCO2균정정상관；D-Dimer、FIB、PLT 여 PaO2균정부상관；APTT、PT、TT 여PaCO2、PaO2무상관성。D-Dimer、PaCO2여SPAP균정정상관；PaO2여SPAP균정부상관。결론대AECOPD환자우기AECOPD합병폐동맥고압환자감측FIB、D-Dimer、PLT、PaCO2、PaO2적변화구유중요개치。
Objective To study the correlation between coagulation fibrinolysis indicators and arterial blood gas levels in AECOPD patients complicated with pulmonary hypertension.Methods 248 patients with AECOPD were selected,and their pulmonary artery systolic pressure (PASP)was measured by echocardiography.They were divided into 4 groups according to PASP:80 cases in the normal PH group (≤30 mmHg),61 cases in the mild PH group (31 ~50 mmHg),57 cases in the moderate PH group (51 ~70 mmHg),and 50 cases in the severe PH group (≥71 mmHg).coagulation fibrinolysis indicators and arterial blood gas analysis were detected from all patients.Re-sults The levels of D-Dimer (D-D)and platelets (PLT)were significantly higher in severe PH group than in the rest three groups.There was no significant difference in FIB and PaCO2 between the severe PH group and the moder-ate PH group and between the mild group and the normal group (P>0.05 ).The level of PaO2 was obviously lower in the severe PH group and the moderate PH group than in the mild group and the normal group (P<0.05 ),but it showed no significance between the severe PH group and the moderate PH group and between the mild group and the normal group (P>0.05 ).There was no significant difference in APTT,PT and TT among the three groups.SPAP was positively correlated with D-Dimer and PaCO2 ,and negatively correlated with PaO2 .PaO2 was negatively correla-ted with FIB and PLT.Conclusion The dynamic monitoring of FIB,D-Dimer,PLT,PaCO2 and PaO2 has an im-portant valve in the treatment of AECOPD patients,especially for those complicated with pulmonary hypertension.