目的 探討還原型谷胱甘肽聯(lián)合低分子肝素治療慢性肺心病急性加重期的臨床效果。方法 選取2018年1月-2019年1月南陽醫(yī)學(xué)高等?？茖W(xué)校第二附屬醫(yī)院收治的慢性肺心病急性加重期患者129例，隨機(jī)分為對(duì)照組（64例）和治療組（65例）。對(duì)照組皮下注射低分子肝素注射液，5 000 AXa/次，2次/d。治療組在對(duì)照組的基礎(chǔ)上靜脈滴注注射用還原型谷胱甘肽，1.5 g加入生理鹽水100 mL，1次/d。兩組患者治療2周。觀察兩組患者臨床療效，同時(shí)比較治療前后兩組患者動(dòng)脈血二氧化碳分壓（pCO₂）、血氧分壓（pO₂）和動(dòng)脈血氧飽和度（SaO₂）指標(biāo)，左室射血分?jǐn)?shù)（LVEF）、每搏輸出量（SV）、心輸出量（CO）、1秒用力呼吸容積（FEV1）、呼吸流量峰值（PEF）、肺活量（FVC）、血細(xì)胞比容、血紅蛋白、D-二聚體、纖維蛋白原、血過氧化脂質(zhì)（LPO）、丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽過氧化物酶（GSH-Px）和氧化氫酶（CAT）水平。結(jié)果 治療后，對(duì)照組和治療組臨床有效率分別為79.70%和92.31%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者pCO₂、血細(xì)胞比容、血紅蛋白、D-二聚體、纖維蛋白原、LPO、MDA水平較治療前顯著降低（P<0.05），pO₂、SaO₂、LVEF、SV、CO、FEV1、PEF、FVC、SOD、GSH-Px及CAT水平較治療前顯著升高（P<0.05），且治療組患者這些指標(biāo)明顯好于對(duì)照組（P<0.05）。結(jié)論 還原型谷胱甘肽聯(lián)合低分子肝素治療慢性肺心病急性加重期臨床療效確切，可改善患者臨床癥狀及心肺功能，并改善血液黏稠度及機(jī)體抗氧化能力。

Objective To investigate the clinical effect of reduced glutathione combined with low molecular weight heparin in treatment of acute exacerbation of chronic pulmonary heart disease. Methods Patients (129 cases) with acute exacerbation of chronic pulmonary heart disease in the Second Affiliated Hospital of Nanyang Medical College from January 2018 to January 2019 were randomly divided into control (64 cases) and treatment (64 cases) groups. Patients in the control group were subcutaneous injection administered with Low Molecular Weight Heparin Calcium Injection, 5 000 AXa/time, twice daily. Patients in the treatment group were iv administered with Reduced Glutathione for injection on the basis of the control group, 1.5 g added into normal saline 150 mL, once daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the pCO₂, pO₂ SaO₂, LVEF, SV, CO, FEV1, PEF, FVC, hematocrit, hemoglobin, D-dimer, fibrinogen, LPO, MDA, SOD, GSH-Px and CAT levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy and in the control and treatment groups was 79.70% and 92.31%, respectively, and there were differences between two groups (P<0.05). After treatment, the pCO₂, hematocrit, hemoglobin, D-dimer, fibrinogen, LPO, MDA levels in two groups were significantly decreased (P<0.05), but the pO₂, SaO₂, LVEF, SV, CO, FEV1, PEF, FVC, SOD, GSH-Px and CAT levels were significantly increased (P<0.05), and these indexes in the treatment group were significantly better than those in the control group (P<0.05). Conclusion Reduced glutathione combined with low molecular weight heparin in treatment of acute exacerbation of chronic pulmonary heart disease has definite clinical efficacy, can improve the clinical symptoms and cardiopulmonary function, and improve blood viscosity and antioxidant capacity.

R974