内科

目的分析无创机械通气与低分子肝素联合治疗慢性阻塞性肺疾病急性加重（AECOPD）合并肺心病心力衰竭患者的疗效及对血清N端前体脑钠肽(NT-pro BNP)、D-二聚体（D-D)水平的影响。方法将2013年6月至2016年6月我院收治的AECOPD合并肺心病心力衰竭患者166例随机分为观察组和对照组，每组83例。对照组患者采用低分子肝素治疗；观察组患者在低分子肝素治疗的基础上，使用无创机械通气治疗，比较两组患者的临床疗效，血液流变学指标、肺功能的变化以及血清NT-pro BNP、D-D水平。结果观察组患者的治疗总有效率（97.59%）显著高于对照组（89.16%），临床疗效优于对照组（P＜0.05）。治疗后两组患者全血高切黏度、全血低切黏度、血浆黏度以及红细胞压积水平均显著下降（P＜0.05），观察组患者显著低于对照组（P＜0.01）；治疗后两组患者FVC、FEV1、PaO2、以及DLCO水平均显著提高（P＜0.05），观察组患者显著高于对照组（P＜0.01）；治疗后两组患者NT-Pro BNP、D-D水平均显著降低（P＜0.05），观察组患者显著低于对照组（P＜0.01）。结论与单纯使用低分子肝素治疗比较，无创机械通气与低分子肝素联合治疗AECOPD合并肺心力衰竭患者，可显著降低患者的血液黏稠度，有效改善患者的心肺功能，提高临床治疗效果。

ObjectiveTo analyze the effect of noninvasive mechanical ventilation combined with low molecular weight heparin on the treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with cor pulmonale with heart failure and its influence on the levels of serum NT-Pro BNP, D-D. MethodsA total of 166 cases of patients with AECOPD complicated with cor pulmonale with heart failure treated in our hospital from June 2013 to June 2016 were selected and randomly divided into observation group and control group, with 83 cases in each group. The control group were treated with low molecular heparin, while the observation group received noninvasive mechanical ventilation on the basis of low molecular heparin. Clinical effect, blood rheology indexes, pulmonary function changes, the levels of serum NT-pro BNP, and D-D were compared between two groups. ResultsThe total effective rate of the observation group (97.59%) was significantly higher than that of the control group (89.16%), and the curative effect in the observation group was significantly superior to that in the control (P＜0.05). After treatment, the levels of low and high shear viscosity of whole blood, plasma viscosity and hematocrit in the two groups were significantly decreased compared with those before treatment(P＜0.05), and the decreased in the observation group was more significant (P＜0.01); the levels of forced vital capacity (FVC), forced expiratory volume (FEV1), arterial oxygen pressure (PaO2), and carbon monoxide diffusion volume (DLCO) in the two groups were significantly increased compared with those before treatment(P＜0.05), and the increased in the observation group was more significant (P＜0.01); the levels of NT-pro BNP, D-D in the two groups were significantly decreased compared with those before treatment(P＜0.05), and the decreased in the observation group was more significant (P＜0.01). ConclusionsCompare to low molecular weight heparin, noninvasive mechanical ventilation combined with low molecular weight heparin on patients with AECOPD complicated with cor pulmonale with heart failure, can decrease the level of blood viscosity significantly, and effectively improve cardiopulmonary function and the curative effect.