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甲泼尼龙联合利伐沙班治疗慢性阻塞性肺疾病急性加重期合并肺栓塞的临床疗效
范昌碧,孙娜,陈桂秀,李雪璐
0
(南充市中心医院呼吸内科;南充市中心医院内分泌科;南充市中心医院心血管内科;川北医学院微生物与免疫教研室)
摘要:
目的 探讨甲泼尼龙联合利伐沙班治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并肺栓塞的疗效及对心肌缺血缺氧性损伤的影响。方法 回顾性分析南充市中心医院2014年2月~2018年2月收治的96例AECOPD合并肺栓塞患者的临床资料,根据治疗方式分为观察组(n=48)和对照组(n=48))。对照组在常规治疗基础上给予利伐沙班治疗,观察组在对照组基础上再联合甲泼尼龙治疗。比较两组治疗疗效、不良反应发生情况、治疗前后凝血功能、D-二聚体、肺功能、血气分析、cTnI及炎性指标水平的变化。〖HTH〗结果 观察组治疗总有效率高于对照组(P<0.05)。治疗后,两组患者FEV-1、FVC、FEV-1/FVC水平及6min步行距离均高于治疗前,且观察组高于对照组(均P<0.05)。治疗后,两组APTT、PT、FIB、TT、D二聚体水平均低于治疗前,FIB水平高于治疗前(均P<0.05);观察组D-二聚体水平低于对照组(P<0.05)。治疗后,两组患者血清PCT、CRP及IL-6水平均低于治疗前,且观察组低于对照组(均P<0.05)。治疗后,两组患者血清PaCO2、cTnI水平低于治疗前,PaO2高于治疗前(均P<0.05),且观察组血清PaCO2、cTnI水平低于对照组,PaO2水平高于对照组(均P<0.05)。两组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 甲泼尼龙联合利伐沙班治疗AECOPD合并肺栓塞患者临床疗效显著,可有效提高患者肺功能,改善血液高凝状态、血气分析及心肌缺血缺氧性损伤,且无严重不良反应。
关键词:  甲泼尼龙  利伐沙班  急性加重期COPD  肺栓塞  心肌缺血缺氧性损伤
DOI:
基金项目:四川省自然科学基金(201276623)
Effect of methylprednisolone combined with rivaroxaban on acute exacerbated COPD combined with pulmonary embolism
FAN Changbi,SUN Na,CHEN Guixiu,LI Xuelu
(Respiratory Medicine,Nanchong Central Hospital;Endocrine Department,Nanchong Central Hospital;Internal MedicineCardiovascular Department,Nanchong Central Hospital;Department of Microbiology and Immunology, North Sichuan Medical College)
Abstract:
Objective To investigate the effect of methylprednisolone combined with rivaroxaban on myocardial ischemia and hypoxia injury for acute exacerbated COPD combined with pulmonary embolism. Methods The clinical data of 96 patients with acute exacerbated COPD combined with pulmonary embolism admitted to our hospital from February 2014 to February 2018 were retrospectively analyzed. The patients were divided into observation group and control group (48 cases each), according to the different treatment methods. The control group was given rivaroxaban combined with routine treatment, and based on this. The observation group was treated with methylprednisolone. Then the curative effect, occurrence of adverse reactions, coagulation function, D-dimer, lung function, blood gas analysis, cTnI, and inflammatory index levels before and after treatment were compared between the two groups. Results he total effective rate in the observation group was higher than that in the control group (89.58% vs 72.92%, X2=4.376,P=0.036). After treatment, the levels of FVC, FEV1, FEV1/FVC, and 6minute walking distance were increased in both groups (P<0.05), and were higher in the observation group than in the control group (P<0.05). After treatment, the APTT, PT, FIB, TT, and Ddimer levels in the two groups were decreased, and FIB level was increased (P<0.05). The APTT, PT, FIB, TT, and FIB levels of the two groups had no significant difference (P>0.05). While the Ddimer level in the observation group was lower than that in the control group (P<0.05). After treatment, serum levels of PCT, CRP and IL6 in the two groups were decreased (P<0.05), and were lower in the observation group than in the control group (P<0.05). After treatment, serum PaCO2 and cTnI levels in the two groups were decreased, and PaO2 was increased (P<0.05), and the observation group had lower levels of PaCO2 and cTnI and higher level of PaO2 than those in the control group (P<0.05). The overall incidence rate of adverse reactions of two groups was not statistically different [14.58% VS 10.42%, X2= 0.381, P=0.537]. Conclusion 〓The methylprednisolone combined with rivaroxaban can effectively ameliorate the lung function, blood hypercoagulability, blood gas analysis and myocardial ischemia and hypoxia injury with no serious adverse reactions for patients with acute exacerbated COPD combined with pulmonary embolism. 
Key words:  Methylprednisolone  Rivaroxaban  Acute exacerbated COPD  Pulmonary embolism  Myocardial ischemia and hypoxia injury

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