Department of Critical Care Medicine, Affiliated First People's Hospital, Shanghai Jiao Tong University School of Medcine , Shanghai , China.
COPD. 2014 Apr;11(2):171-6. doi: 10.3109/15412555.2013.831062. Epub 2013 Oct 2.
Severe and acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with a high mortality. Since COPD is an airway inflammatory disease, and heparin has shown anti-inflammatory effects in previous studies, we evaluated the clinical effect of low molecular weight heparin (LMWH; nadroparin) in COPD patients admitted into the hospital due to acute exacerbations.
Sixty-six patients admitted to the intensive care unit (ICU) were randomly divided into control group (n = 33) and LMWH group (n = 33). The control group received conventional treatment, including oxygen therapy (non-invasive or conventional mechanical ventilation), anti-infection, atomization expectorant, spasmolysis, anti-asthmatics, and nutritional support. The LMWH group received the same treatment plus LMWH for 1 week. The levels of plasma C-reactive protein, interleukin-6, and fibrinogen were measured. The main outcomes were duration of mechanical ventilation, length of ICU stay, and hospital stay.
There were no significant differences between the groups with respect to demographics, severity of illness, and gas exchange variables. The levels of plasma C-reactive protein, interleukin-6, and fibrinogen were significantly decreased in the LMWH group. LMWH significantly reduced the mean duration of mechanical ventilation (6.6 days vs. 3.8 days; p < 0.01), the length of ICU stay (8.5 days vs. 5.6 days; p < 0.01) and hospital stay (14.3 days vs. 11.3 days; p < 0.01).
The addition of LMWH to standard therapy benefits COPD patients with acute exacerbation.
慢性阻塞性肺疾病（COPD）的严重和急性加重与高死亡率相关。由于 COPD 是一种气道炎症性疾病，肝素在先前的研究中显示出抗炎作用，因此我们评估了低分子量肝素（LMWH；那屈肝素）在因急性加重而住院的 COPD 患者中的临床效果。
66 名入住重症监护病房（ICU）的患者被随机分为对照组（n = 33）和 LMWH 组（n = 33）。对照组接受常规治疗，包括氧疗（无创或有创机械通气）、抗感染、雾化祛痰、解痉、平喘和营养支持。LMWH 组接受相同的治疗，外加 LMWH 治疗 1 周。测量血浆 C 反应蛋白、白细胞介素-6 和纤维蛋白原水平。主要结局是机械通气时间、ICU 住院时间和住院时间。
两组在人口统计学、疾病严重程度和气体交换变量方面无显著差异。LMWH 组血浆 C 反应蛋白、白细胞介素-6 和纤维蛋白原水平显著降低。LMWH 显著缩短了机械通气的平均时间（6.6 天 vs. 3.8 天；p < 0.01）、ICU 住院时间（8.5 天 vs. 5.6 天；p < 0.01）和住院时间（14.3 天 vs. 11.3 天；p < 0.01）。
在标准治疗的基础上加用 LMWH 可使 COPD 急性加重患者受益。
