麝香保心丸联合酚妥拉明治疗慢性肺源性心脏病急性加重期的临床研究
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摘要
目的探讨麝香保心丸联合酚妥拉明治疗慢性肺源性心脏病急性加重期的临床效果。方法选取2017年1月—2018年6月亳州市人民医院收治的72例慢性肺源性心脏病急性加重期患者,随机分为对照组和治疗组,每组各36例。对照组静脉滴注甲磺酸酚妥拉明注射液,20 mg加入5%葡萄糖液250 mL中均匀混合后缓慢给药,1次/d。治疗组在对照组基础上口服麝香保心丸,2丸/次,3次/d。两组均连续治疗7 d。观察两组的临床疗效,比较两组治疗前后血气指标、高凝状态指标、超声心动图指标、肺功能指标、内皮素-1(ET-1)和C反应蛋白(CRP)的变化情况。结果治疗后,对照组和治疗组的总有效率分别是77.8%、94.4%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组动脉血氧(pO_2)较治疗前均显著升高,而二氧化碳分压(pCO_2)、纤维蛋白原(FIB)、D-二聚体(D-D)均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,治疗组pO_2值高于对照组,而pCO_2、FIB、D-D均低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组右心室内径(RVD)、肺动脉收缩压(PASP)较治疗前均显著降低,而右室面积变化分数(FAC)、E峰减速时间(EDT)均显著增高,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,治疗组RVD、PASP显著低于对照组,而FAC、EDT高于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组第1秒用力呼气容积(FEV1)、最大呼气中段流量占预计值百分比(MMEF%pred)较治疗前均显著升高,而ET-1、CRP均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,治疗组FEV1、MMEF%pred显著高于对照组,而ET-1、CRP低于对照组,两组比较差异具有统计学意义(P<0.05)。结论麝香保心丸联合酚妥拉明治疗慢性肺源性心脏病急性加重期的整体疗效显著,有利于纠正患者体内缺氧和二氧化碳潴留,改善血液高凝状态,保护心肺功能,具有一定的临床推广应用价值。
Objective To investigate the clinical effect of Shexiang Baoxin Pills combined with phentolamine in treatment of acute exacerbations of chronic pulmonary heart disease. Methods Patients(72 cases) with acute exacerbations of chronic pulmonary heart disease in Bozhou People's Hospital from January 2017 to June 2018 were randomly divided into control(36 cases) and treatment(36 cases) groups. Patients in the control group were iv administered with Phentolamine Mesilate Injection, 20 mg was added to 5% glucose solution 250 mL and mixed evenly, once daily. Patients in the treatment group were po administered with Shexiang Baoxin Pills on the basis of the control group, 2 pills/time, three times daily. Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the changes of blood gas indexes, hypercoagulability indexes, echocardiography indexes, pulmonary function indexes, ET-1 and CRP in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 77.8% and 94.4%, respectively, and there were differences between two groups(P < 0.05). After treatment, pO_2 in two groups were significantly increased, but pCO_2, FIB, and D-D were significantly decreased, and there were differences in the same group(P < 0.05). After treatment, the pO_2 in the treatment group were higher than those in the control group, but pCO_2, FIB, and D-D were lower than those in the control group, and there were differences between two groups(P < 0.05). After treatment, RVD and PASP in two groups were significantly decreased, but FAC and EDT were significantly increased, and there were differences in the same group(P < 0.05). After treatment, the RVD and PASP in the treatment group were lower than those in the control group, but FAC and EDT were higher than those in the control group, and there were differences between two groups(P < 0.05). After treatment, FEV1 and MMEF%pred in two groups were significantly increased, but ET-1 and CRP were significantly decreased, and there were differences in the same group(P < 0.05). After treatment, the FEV1 and MMEF%pred in the treatment group were higher than those in the control group, but ET-1 and CRP were lower than those in the control group, and there were differences between two groups(P < 0.05). Conclusion Shexiang Baoxin Pills combined with phentolamine has significant effect in treatment of acute exacerbations of chronic pulmonary heart disease, and is helpful to correct hypoxia and carbon dioxide retention in patients, and improve blood hypercoagulability, and protect cardiopulmonary function, which has a certain clinical application value.
Objective To investigate the clinical effect of Shexiang Baoxin Pills combined with phentolamine in treatment of acute exacerbations of chronic pulmonary heart disease. Methods Patients(72 cases) with acute exacerbations of chronic pulmonary heart disease in Bozhou People's Hospital from January 2017 to June 2018 were randomly divided into control(36 cases) and treatment(36 cases) groups. Patients in the control group were iv administered with Phentolamine Mesilate Injection, 20 mg was added to 5% glucose solution 250 mL and mixed evenly, once daily. Patients in the treatment group were po administered with Shexiang Baoxin Pills on the basis of the control group, 2 pills/time, three times daily. Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the changes of blood gas indexes, hypercoagulability indexes, echocardiography indexes, pulmonary function indexes, ET-1 and CRP in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 77.8% and 94.4%, respectively, and there were differences between two groups(P < 0.05). After treatment, pO_2 in two groups were significantly increased, but pCO_2, FIB, and D-D were significantly decreased, and there were differences in the same group(P < 0.05). After treatment, the pO_2 in the treatment group were higher than those in the control group, but pCO_2, FIB, and D-D were lower than those in the control group, and there were differences between two groups(P < 0.05). After treatment, RVD and PASP in two groups were significantly decreased, but FAC and EDT were significantly increased, and there were differences in the same group(P < 0.05). After treatment, the RVD and PASP in the treatment group were lower than those in the control group, but FAC and EDT were higher than those in the control group, and there were differences between two groups(P < 0.05). After treatment, FEV1 and MMEF%pred in two groups were significantly increased, but ET-1 and CRP were significantly decreased, and there were differences in the same group(P < 0.05). After treatment, the FEV1 and MMEF%pred in the treatment group were higher than those in the control group, but ET-1 and CRP were lower than those in the control group, and there were differences between two groups(P < 0.05). Conclusion Shexiang Baoxin Pills combined with phentolamine has significant effect in treatment of acute exacerbations of chronic pulmonary heart disease, and is helpful to correct hypoxia and carbon dioxide retention in patients, and improve blood hypercoagulability, and protect cardiopulmonary function, which has a certain clinical application value.
引文
[1]程显声,李景周,张珍祥.慢性阻塞性肺疾病、肺心病人群防治的研究基线资料分析[J].中华结核和呼吸杂志, 1998, 21(12):749-752.
[2]刘秀碧. 80例慢性肺源性心脏病急性加重期临床分析[J].中国医药指南, 2008, 6(5):41-42.
[3]陈冬元.酚妥拉明的临床应用近况[J].中国医师进修杂志, 1993, 16(7):45-47.
[4]王仙,徐传新,朱慧娟.麝香保心丸的心血管系统药理作用研究进展[J].中国药房, 2012, 23(43):4114-4116.
[5]史乃楷.慢性肺原性心脏病诊断标准(1977年全国第二次肺心病专业会议修订)[J].山西医药杂志, 1982,11(1):35-39.
[6]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中华人民共和国卫生部, 1993:52-56.
[7]崔良英.慢性肺源性心脏病急性加重期患者40例的临床观察[J].中国社区医师:医学专业, 2012, 14(15):167.
[8]张玉强,蒲文全,王宝平,等.慢性肺源性心脏病急性加重期血管活性药物应用进展[J].社区医学杂志,2004, 2(1):30-32.
[9]张惠民.酚妥拉明的药理与儿科临床应用[J].中国农村医学, 1991, 19(2):34-35.
[10]宋华.麝香保心丸的药理研究与临床评价[J].中成药, 2002, 24(2):131-133.
[11]刘群,吕超,张卫东,等.麝香保心丸研究进展[J].中草药, 2016, 47(8):1409-1417.
[12]张丽.麝香保心丸对肺心病急性加重期治疗作用的观察[J].中医药临床杂志, 2014, 26(4):354-355.
[13]黄波,谭天海,吴会超,等.慢性肺源性心脏病急性加重期80例动脉血气分析特点[J].遵义医学院学报,1996, 19(Z1):240-242.
[14]郑素歌,曹英,张占胜.慢性肺原性心脏病急性加重期血液高凝状态的临床观察[J].临床内科杂志, 2001,18(5):352-353.
[15]田甜,赵蓉,杨倩玫,等.超声心动图对不同病程的慢性肺源性心脏病患者右心功能改变的评估[J].中国超声医学杂志, 2018, 34(3):228-231.
[16]史国欣.慢性支气管炎、慢性肺源性心脏病、COPD患者不同时期BNP、肺功能、动脉血气的变化情况分析[J].社区医学杂志, 2015, 13(11):61-63.
[17]喻延,杜曦明,易慧虹,等.肺心病患者血浆内皮素-1水平变化及其临床意义[J].广东医学, 1999, 20(6):415-416.
[18]刘进宝,计学理,李亚宁,等.慢性肺源性心脏病患者C-反应蛋白与白细胞介素-8的检测分析[J].中西医结合心脑血管病杂志, 2008, 6(10):1231-1232.
[2]刘秀碧. 80例慢性肺源性心脏病急性加重期临床分析[J].中国医药指南, 2008, 6(5):41-42.
[3]陈冬元.酚妥拉明的临床应用近况[J].中国医师进修杂志, 1993, 16(7):45-47.
[4]王仙,徐传新,朱慧娟.麝香保心丸的心血管系统药理作用研究进展[J].中国药房, 2012, 23(43):4114-4116.
[5]史乃楷.慢性肺原性心脏病诊断标准(1977年全国第二次肺心病专业会议修订)[J].山西医药杂志, 1982,11(1):35-39.
[6]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中华人民共和国卫生部, 1993:52-56.
[7]崔良英.慢性肺源性心脏病急性加重期患者40例的临床观察[J].中国社区医师:医学专业, 2012, 14(15):167.
[8]张玉强,蒲文全,王宝平,等.慢性肺源性心脏病急性加重期血管活性药物应用进展[J].社区医学杂志,2004, 2(1):30-32.
[9]张惠民.酚妥拉明的药理与儿科临床应用[J].中国农村医学, 1991, 19(2):34-35.
[10]宋华.麝香保心丸的药理研究与临床评价[J].中成药, 2002, 24(2):131-133.
[11]刘群,吕超,张卫东,等.麝香保心丸研究进展[J].中草药, 2016, 47(8):1409-1417.
[12]张丽.麝香保心丸对肺心病急性加重期治疗作用的观察[J].中医药临床杂志, 2014, 26(4):354-355.
[13]黄波,谭天海,吴会超,等.慢性肺源性心脏病急性加重期80例动脉血气分析特点[J].遵义医学院学报,1996, 19(Z1):240-242.
[14]郑素歌,曹英,张占胜.慢性肺原性心脏病急性加重期血液高凝状态的临床观察[J].临床内科杂志, 2001,18(5):352-353.
[15]田甜,赵蓉,杨倩玫,等.超声心动图对不同病程的慢性肺源性心脏病患者右心功能改变的评估[J].中国超声医学杂志, 2018, 34(3):228-231.
[16]史国欣.慢性支气管炎、慢性肺源性心脏病、COPD患者不同时期BNP、肺功能、动脉血气的变化情况分析[J].社区医学杂志, 2015, 13(11):61-63.
[17]喻延,杜曦明,易慧虹,等.肺心病患者血浆内皮素-1水平变化及其临床意义[J].广东医学, 1999, 20(6):415-416.
[18]刘进宝,计学理,李亚宁,等.慢性肺源性心脏病患者C-反应蛋白与白细胞介素-8的检测分析[J].中西医结合心脑血管病杂志, 2008, 6(10):1231-1232.