法舒地尔联合无创呼吸技术支持对肺心病伴呼吸衰竭患者肺功能的影响
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摘要
目的探讨法舒地尔联合无创呼吸技术支持对肺心病伴呼吸衰竭患者肺功能的保护效果。方法 150例慢性肺源性心脏病伴呼吸衰竭患者根据治疗方式分为观察组(n=78)和对照组(n=72),对照组在常规治疗基础上给予无创呼吸技术支持治疗,观察组在对照组基础上加用法舒地尔进行治疗,观察比较两组患者治疗后临床疗效,治疗前后血气指数(PaO_2、Pa CO2、SaO_2),心功能指标(CO、CI、EF),肺动脉收缩压(PASP),肺功能指标(FEV_1pred、FEV_1/FVC)及血浆中ET-1、NO、hs-CRP、NTpro BNP含量变化,同时记录两组患者治疗期间不良反应发生情况。结果观察组患者治疗有效率为96.15%,显著高于对照组83.33%(P<0.05),两组患者治疗后PaO_2、SaO_2、FEV_1pred和FEV_1/FVC较治疗前显著升高(P<0.05),且与对照组比较,观察组患者PaO_2和FEV_1pred指标显著升高(P<0.05)。治疗后两组患者NO、CO、CI、EF治疗较治疗前显著升高(P<0.05),而ET-1、hs-CRP、NT-pro BNP和PASP治疗较治疗前显著降低(P<0.05),且与对照组比较,观察组患者NO、CO、CI、EF指标显著升高(P<0.05),而ET-1、hs-CRP、NT-pro BNP、PASP指标显著降低(P<0.05)。两组患者不良反应发生率比较,差异不具有统计学意义(P>0.05)。结论法舒地尔联合无创呼吸技术支持治疗能够显著改善肺心病伴呼吸衰竭患者肺通气功能,能够通过降低肺动脉收缩压及血浆脑钠肽水平改善患者心功能,其疗效显著优于单用无创呼吸治疗。
Objective To explore the protective effect of fasudil combined with noninvasive breathing technique support on the pulmonary function in the patients with pulmonary heart disease complicated with respiratory failure. Methods A total of 150 patients with chronic pulmonary heart disease complicated with respiratory failure were divided into an observation group( n = 78) and a control group( n = 72) according to the treatment methods. The control group was given the noninvasive breathing technique support on the basis of conventional therapy,and the observation group was additionally given fasudil on the basis of the control group.The clinical efficacy after treatment,the levels of blood gas indexes( PaO_2,PaCO_2,and SaO_2),the heart function indexes( CO,CI,and EF),PASP,the pulmonary function indexes( FEV1 pred and FEV1/FVC) and plasma ET-1,NO,hs-CRP,NT-pro BNP before and after treatment were observed and compared between the two groups,and the adverse reactions during treatment were recorded in the two groups. Results The treatment effective rate in the observation group was significantly higher than that in the control group( 96. 15% vs.83.33%,P< 0. 05),the levels of PaO_2,SaO_2,FEV1 pred and FEV1/FVC in the two groups after treatment were significantly higher than those before treatment( P<0.05). Compared with the control group,the levels of PaO_2 and FEV1 pred index were significantly increased in the observation group( P<0.05). After treatment,the levels of NO,CO,CI and EF in the two groups were significantly higher than those before treatment( P<0.05)while the levels of ET-1,hs-CRP,NT-pro BNP and PASP were significantly lower than those before treatment( P < 0. 05). Compared with the control group,the index levels of NO,CO,CI and EF were increased significantly( P < 0. 05) while the index levels of ET-1,hs-CRP,NT-pro BNP and PASP were decreased significantly( P<0.05) in the observation group. There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05). Conclusion Fasudil combined with noninvasive breathing technique support can significantly improve the pulmonary ventilation function in the patients with pulmonary heart disease complicated with respiratory failure,and can improve the patient' s cardiac function by reducing the levels of pulmonary systolic pressure and plasma brain natriuretic peptide,and its efficacy is significantly better than that of the noninvasive breathing therapy.
Objective To explore the protective effect of fasudil combined with noninvasive breathing technique support on the pulmonary function in the patients with pulmonary heart disease complicated with respiratory failure. Methods A total of 150 patients with chronic pulmonary heart disease complicated with respiratory failure were divided into an observation group( n = 78) and a control group( n = 72) according to the treatment methods. The control group was given the noninvasive breathing technique support on the basis of conventional therapy,and the observation group was additionally given fasudil on the basis of the control group.The clinical efficacy after treatment,the levels of blood gas indexes( PaO_2,PaCO_2,and SaO_2),the heart function indexes( CO,CI,and EF),PASP,the pulmonary function indexes( FEV1 pred and FEV1/FVC) and plasma ET-1,NO,hs-CRP,NT-pro BNP before and after treatment were observed and compared between the two groups,and the adverse reactions during treatment were recorded in the two groups. Results The treatment effective rate in the observation group was significantly higher than that in the control group( 96. 15% vs.83.33%,P< 0. 05),the levels of PaO_2,SaO_2,FEV1 pred and FEV1/FVC in the two groups after treatment were significantly higher than those before treatment( P<0.05). Compared with the control group,the levels of PaO_2 and FEV1 pred index were significantly increased in the observation group( P<0.05). After treatment,the levels of NO,CO,CI and EF in the two groups were significantly higher than those before treatment( P<0.05)while the levels of ET-1,hs-CRP,NT-pro BNP and PASP were significantly lower than those before treatment( P < 0. 05). Compared with the control group,the index levels of NO,CO,CI and EF were increased significantly( P < 0. 05) while the index levels of ET-1,hs-CRP,NT-pro BNP and PASP were decreased significantly( P<0.05) in the observation group. There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05). Conclusion Fasudil combined with noninvasive breathing technique support can significantly improve the pulmonary ventilation function in the patients with pulmonary heart disease complicated with respiratory failure,and can improve the patient' s cardiac function by reducing the levels of pulmonary systolic pressure and plasma brain natriuretic peptide,and its efficacy is significantly better than that of the noninvasive breathing therapy.
引文
1纪颖,张洪玉,安晓杰,等.无创正压机械通气对老年慢性肺心病伴Ⅱ型呼吸衰竭患者的疗效观察[J].实用老年医学,2016,7(30):548-551.
2 王秋婷,何海武,石慧芳,等.老年呼吸衰竭伴慢性肺心病患者血浆血小板活化因子及血小板功能的变化[J].山东医药,2017,57(25):83-84.
3 李亚清,严建平,许武林,等.双水平气道正压通气对老年慢性肺源性心脏病合并Ⅱ型呼吸衰竭患者血浆N-端脑利钠肽前体水平的影响[J].中华老年医学杂志,2014,33(11):1157-1160.
4 李新,梁宗安.无创通气联合法舒地尔应用于老年慢性肺心病合并呼吸衰竭患者的疗效观察[J].医学综述,2015,21(8):1491-1493.
5 周松林,徐文波.无创机械通气治疗慢性肺源性心脏病合并Ⅱ型呼吸衰竭的临床疗效[J].中国现代医学杂志,2015,25(12):106-109.
6 艾娜娜,黎晌,钟昌明,等.Rho激酶/ROCK在心脑血管方面的研究进展[J].现代生物医学进展,2015,15(21):4198-4200.
7 陈卓宏,黄凯,韦斌,等.法舒地尔对缺血性心肌病患者血管内皮功能的影响[J].广西医科大学学报,2014,31(3):390-392.
8 付祥玲,任金林.无创机械通气治疗慢性肺源性心脏病合并Ⅱ型呼吸衰竭的临床疗效研究[J].实用心脑肺血管病杂志,2016,01(24):147-149.
9 复旦大学上海医学院.实用内科学-第13版[M].人民卫生出版社,2009:567-581.
10 马涵涛.米力农治疗老年慢性肺心病心力衰竭的疗效观察[J].中国新药与临床杂志,2014,33(7):538-541.
11 樊楚明,杨欣悦,孔晖,等.慢性阻塞性肺疾病呼吸衰竭合并肺部真菌感染患者死亡的影响因素研究[J].中国全科医学,2015,18(7):779-782.
12 鲁西亮,黄相增.无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的疗效观察[J].实用医学杂志,2015,31(17):2842-2844.
13 秦北宁,宋永辉,刘新颖,等.慢性阻塞性肺疾病患者呼吸衰竭有创机械通气治疗研究[J].中华医院感染学杂志,2015,25(4):849-850.
14 陈天明,卢青,杨锁平,等.无创呼吸机对肺源性心脏病合并呼吸衰竭患者缺氧状态的改善及对脑钠肽和内皮素-1的影响[J].山西医药杂志,2017,46(13):1544-1547.
15 龚璐璐,GONGLU-lu.无创呼吸机对老年慢性肺源性心脏病患者的影响分析[J].实用心脑肺血管病杂志,2016,01(24):115-117.
16 王梅芳,刘玉全,熊畅,等.无创通气联合法舒地尔治疗老年肺心病伴呼吸衰竭患者疗效观察[J].临床肺科杂志,2013,18(4):669-671.
17 余中红.慢性阻塞性肺病肺动脉高压患者发生急性左心衰竭的超声检测[J].心脑血管病防治,2013,13(2):148-149.
18 赖蓉,李多,兰四友,等.法舒地尔联合无创正压通气治疗慢性肺源性心脏病急性加重的临床价值[J].中国现代医学杂志,2016,26(2):55-59.
19 卜丽娜,宋爱玲,贾卫红,等.法舒地尔治疗老年慢性肺源性心脏病临床疗效及其机制的随机对照研究[J].中国全科医学,2017,20(5):538-542.
20 张成果.盐酸法舒地尔对维持性血液透析患者血管内皮功能的保护作用[J].实用医学杂志,2014,30(21):3499-3502.
21 顾顺忠,王世亚,丁宏胜,等.法舒地尔对冠心病心力衰竭患者BNP及hs CRP的影响[J].中西医结合心脑血管病杂志,2015,16(13):1857-1859.
22 孟凡祥.法舒地尔治疗慢性阻塞性肺疾病合并肺动脉高压对NT-pro BNP的影响[J].解放军医药杂志,2016,28(6):97-100.
23 朱娜,胡鑫,黄禹,等.生脉注射液治疗老年慢性肺源性心脏病合并心衰预后疗效[J].辽宁中医药大学学报,2014,16(1):182-183.
24 孙润锋,陈云,杨华.曲美他嗪联合法舒地尔对慢性心力衰竭患者血清和肽素、半乳糖凝集素3和心功能的影响[J].中国新药与临床杂志,2016,35(6):423-426.
25 田昭涛,李慧丽,崔云亮.无创通气联合硫酸镁对肺心病伴呼吸衰竭患者血浆hs-CRP和NT-pro BNP的影响[J].山东医药,2014,54(8):45-46.
2 王秋婷,何海武,石慧芳,等.老年呼吸衰竭伴慢性肺心病患者血浆血小板活化因子及血小板功能的变化[J].山东医药,2017,57(25):83-84.
3 李亚清,严建平,许武林,等.双水平气道正压通气对老年慢性肺源性心脏病合并Ⅱ型呼吸衰竭患者血浆N-端脑利钠肽前体水平的影响[J].中华老年医学杂志,2014,33(11):1157-1160.
4 李新,梁宗安.无创通气联合法舒地尔应用于老年慢性肺心病合并呼吸衰竭患者的疗效观察[J].医学综述,2015,21(8):1491-1493.
5 周松林,徐文波.无创机械通气治疗慢性肺源性心脏病合并Ⅱ型呼吸衰竭的临床疗效[J].中国现代医学杂志,2015,25(12):106-109.
6 艾娜娜,黎晌,钟昌明,等.Rho激酶/ROCK在心脑血管方面的研究进展[J].现代生物医学进展,2015,15(21):4198-4200.
7 陈卓宏,黄凯,韦斌,等.法舒地尔对缺血性心肌病患者血管内皮功能的影响[J].广西医科大学学报,2014,31(3):390-392.
8 付祥玲,任金林.无创机械通气治疗慢性肺源性心脏病合并Ⅱ型呼吸衰竭的临床疗效研究[J].实用心脑肺血管病杂志,2016,01(24):147-149.
9 复旦大学上海医学院.实用内科学-第13版[M].人民卫生出版社,2009:567-581.
10 马涵涛.米力农治疗老年慢性肺心病心力衰竭的疗效观察[J].中国新药与临床杂志,2014,33(7):538-541.
11 樊楚明,杨欣悦,孔晖,等.慢性阻塞性肺疾病呼吸衰竭合并肺部真菌感染患者死亡的影响因素研究[J].中国全科医学,2015,18(7):779-782.
12 鲁西亮,黄相增.无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的疗效观察[J].实用医学杂志,2015,31(17):2842-2844.
13 秦北宁,宋永辉,刘新颖,等.慢性阻塞性肺疾病患者呼吸衰竭有创机械通气治疗研究[J].中华医院感染学杂志,2015,25(4):849-850.
14 陈天明,卢青,杨锁平,等.无创呼吸机对肺源性心脏病合并呼吸衰竭患者缺氧状态的改善及对脑钠肽和内皮素-1的影响[J].山西医药杂志,2017,46(13):1544-1547.
15 龚璐璐,GONGLU-lu.无创呼吸机对老年慢性肺源性心脏病患者的影响分析[J].实用心脑肺血管病杂志,2016,01(24):115-117.
16 王梅芳,刘玉全,熊畅,等.无创通气联合法舒地尔治疗老年肺心病伴呼吸衰竭患者疗效观察[J].临床肺科杂志,2013,18(4):669-671.
17 余中红.慢性阻塞性肺病肺动脉高压患者发生急性左心衰竭的超声检测[J].心脑血管病防治,2013,13(2):148-149.
18 赖蓉,李多,兰四友,等.法舒地尔联合无创正压通气治疗慢性肺源性心脏病急性加重的临床价值[J].中国现代医学杂志,2016,26(2):55-59.
19 卜丽娜,宋爱玲,贾卫红,等.法舒地尔治疗老年慢性肺源性心脏病临床疗效及其机制的随机对照研究[J].中国全科医学,2017,20(5):538-542.
20 张成果.盐酸法舒地尔对维持性血液透析患者血管内皮功能的保护作用[J].实用医学杂志,2014,30(21):3499-3502.
21 顾顺忠,王世亚,丁宏胜,等.法舒地尔对冠心病心力衰竭患者BNP及hs CRP的影响[J].中西医结合心脑血管病杂志,2015,16(13):1857-1859.
22 孟凡祥.法舒地尔治疗慢性阻塞性肺疾病合并肺动脉高压对NT-pro BNP的影响[J].解放军医药杂志,2016,28(6):97-100.
23 朱娜,胡鑫,黄禹,等.生脉注射液治疗老年慢性肺源性心脏病合并心衰预后疗效[J].辽宁中医药大学学报,2014,16(1):182-183.
24 孙润锋,陈云,杨华.曲美他嗪联合法舒地尔对慢性心力衰竭患者血清和肽素、半乳糖凝集素3和心功能的影响[J].中国新药与临床杂志,2016,35(6):423-426.
25 田昭涛,李慧丽,崔云亮.无创通气联合硫酸镁对肺心病伴呼吸衰竭患者血浆hs-CRP和NT-pro BNP的影响[J].山东医药,2014,54(8):45-46.