目的 探讨利伐沙班抗凝治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺动脉高压(pulmonary hypertension,PH)的临床疗效。方法 选取2016-01至2018-01秦皇岛市第一医院呼吸科COPD合并PH住院患者163例为研究对象。收集所有入组患者年龄、性别、体重指数、血常规、肺功能、NT-proBNP、心彩超、动脉血气分析及6 min步行距离等指标。对照组给予常规氧疗,抗炎,化痰及平喘治疗;治疗组在对照组治疗基础上,加用利伐沙班10 mg,1次/d口服抗凝治疗。对两组治疗30 d后心脏彩超、6 min步行距离、动脉血氧分压及二氧化碳分压等数据进行对比分析。结果 两组治疗后各项指标均较治疗前改善,差异有统计学意义(P<0.05)。且治疗组肺动脉压明显低于对照组[(32.7±3.8)mmHg vs.(51.2±2.7)mmHg];治疗组6 min步行距离较对照组比较明显增加[(467.7±5.4)m vs.(397.8±4.8)m],差异均有统计学意义(P<0.05);治疗组的动脉血氧分压较对照组明显升高[(75.6±3.7)mmHg vs. (63.7±4.5)mmHg],而动脉二氧化碳分压较对照组明显下降[(43.6±3.7)mmHg vs. (49.7±2.9)mmHg],差异均有统计学意义(P<0.05)。结论 利伐沙班抗凝治疗对于COPD合并PH疗效较好,明显改善患者生活质量。

Objective To explore the clinical effect of rivaroxaban anticoagulant therapy against chronic obstructive pulmonary disease complicated with pulmonary hypertension.Methods In this study, the clinical data on 163 patients with COPD complicated with pulmonary hypertension admitted to our hospital between January 2016 to January 2018 was collected. Such information as the age, gender, body mass index, 6-minute walk test, NT-proBNP, blood analysis, lung function, arterial blood gas analysis and heart color ultrasound of the patients was collected. The control group was given the routine oxygen therapy as well as anti-inflammatory, phlegm-reducing and antiasthmatic treatment, while the treatment group additionally received rivaroxaban 10mg/day oral anticoagulant therapy.Results of cardiac ultrasound, arterial blood gas analysis and 6-minute walking test were compared between the two groups after 30 days of treatment. The data on pulmonary artery pressure, 6-minute walking distance, arterial oxygen partial pressure and carbon dioxide partial pressure in both groups was statistically analyzed.Results Pulmonary arterial pressure decreased significantly in the experimental group after rivaroxaban anticoagulant treatment compared with the control group[(32.7±3.8) vs(51.2±2.7),(P<0.05)]. The 6-minute walking distance of the experimental group was significantly increased compared with the control group[(467.7±5.4) vs (397.8±4.8),(P<0.05)]. The partial pressure of arterial oxygen in the experimental group was significantly higher than that of the control group[(75.6±3.7) vs (63.7±4.5),(P<0.05)]. Arterial partial pressure of carbon dioxide decreased significantly compared with the control group[(43.6±3.7) vs(49.7±2.9)]. The above indexes in the experimental group were significantly improved compared with the control group, and the difference was statistically significant.Conclusions Rivaroxaban anticoagulant therapy has a good clinical effect on chronic obstructive pulmonary disease complicated with pulmonary hypertension, It can improve the quality of life and prognosis of patients.