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。%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.
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