Elderly Patients With Chronic Obstructive Pulmonary Disease With Acute Exacerbation Of Concurrency And Countermeasures Change Coagulation In Patients With Respiratory Failure

Objective: To study the levels of D-dimer, fibrinogen level, blood pressure, carbon dioxide partial pressure, inflammatory markers leukocytes, C reactive protein and lung function in elderly patients with AECOPD concurrent respiratory failure and multiple organ dysfunction syndrome(MODS) to investigate the relationships between the changes in the severity of the disease in elderly patients with AECOPD and the coagulation function, to predict a patient’s condition and prognosis.Methods: 60 patients aged were over 65 years with AECOPD were selected in 2013-2014, including: 25 patients with simple AECOPD(AECOPD group), 20 patients with AECOPD and respiratory failure(RF group), 15 patients with AECOPD complicated by MODS(MODS group). Coagulation disorders, surgery and with in six months had a history of trauma, merge thrombotic disease, lung cancer, pulmonary embolism and other serious respiratory diseases and nearly two weeks taking anticoagulants and antiplatelet aggregation affect coagulation were While excluded. 25 healthy people were randomly selected(control group). The following indicators of 85 subjects were detected: coagulation, blood gas, inflammatory markers. platelet(PLT), D- dimer(DD), fibrinogen(FBG), prothrombin time(PT), activated partial thromboplastin time(APTT) were detected. Plasma DD, PT, APTT, FBG in fasting venous blood was measured by immune nephelometry. Blood gas analysis was detected using a dedicated heparin syringes take radial or femoral artery, forearm arterial 1ml, recording temperature and whether the oxygen. Inflammatory indicators including leukocyte(WBC), C-reactive protein(CRP), CRP were detected by immune fluorescence dry quantitative method; WBC was detected using Beckman automated hematology analyzer. FEV1%Pred of all subjects were tested. Finally, the statistical analysis of differences and the correlation between groups and coagulation, blood gas, inflammatory markers were conducted.Results: Compared with control group, DD、FBG in AECOPD patients increased and statistically significant(P <0.05), PLT, PT, APTT tended to increase, but not statistically significant(P> 0.05). The level of D-D in control group、AECOPD group、RF group、MODS group were: 71.34±8.71,298.88±154.66,493.35±390.13,1098.40±506.22, statistically significant(P<0.01);The level of FBG in the four groups were: 2.95±0.70,3.94±0.84,4.00±1.45,5.59±1.69 were statistically significant(P<0.05);The difference was statistically significant when AECOPD group vs control group and MODS group vs respiratory failure group(P<0.05),AECOPD group and RF group for FBG had no statistically significant(P> 0.05).The level of WBC in control group、AECOPD group、RF group、MODS group were:8.52±1.18,10.13±3.96,10.59±3.45,10.89±3.22,The one-way ANOVA, WBC in AECOPD patients than in control group, in AECOPD group、RF group、MODS group three groups tended to increase, but not statistically significant(P> 0.05). The level of CRP in the four groups were:3.86±2.78,37.14±47.29,67.46±50.30,74.09±65.05, CRP among the four groups in the study were statistically different(P <0.05). Pair wise comparisons using LSD method, the results are as follows: MODS group 、RF group were significantly higher than in control group 、AECOPD group, statistically different(P <0.01), but MODS group 、 RF group had no statistically significant(P> 0.05).Control group、AECOPD group、RF group、MODS group studied between blood and lung function levels were statistically different(P <0.05). The level of Pa O2 were 84.08±3.73,73.62±6.38,50.97±7.5,47.12±6.66 decreased gradually, statistically different(P <0.05); The level of Pa CO2 were 38.76±4.03,41.23±3.3,56.16±10.8,74.89±13.99 increased gradually. The level of FEV1%Pred in the four groups were: 89.64±4.32,57.96±10.88,40.15±13.38,33.20±8.65,FEV1%Pred decreased, were statistically significant(P < 0.01).Coagulation DD, FBG were negatively correlated with Pa O2(r=-0.732,-0.614), positively correlated with Pa CO2(r=0.839,0.612), were statistically significant(P <0.05); PLT respectively Pa O2, Pa CO2 no correlation(P> 0.05).Coagulation DD, FBG, PLT were associated with FEV1%Pred was negatively correlated(r=-0.745,-0.611,-0.303), were statistically significant(P <0.05)Coagulation DD, FBG, PLT were positively correlated with WBC(r=0.466,0.450,0.311)and CRP(r= 0.694,0.586,0.357), were statistically significant(P <0.05).Conclusions: AECOPD elderly patient’s blood in a hyper coagulable state, especially with respiratory failure and multiple organ failure were more serious. The change of coagulation and inflammation in patients with pulmonary function, level, hypoxia and hyper capnia is closely related to. AECOPD monitoring in patients with coagulation is more conductive to the evaluation of patients with the disease, inflammatory state, thrombosis risk to facilitate the evaluation of patients with the disease, inflammation, thrombosis risk of complications.