麻杏五子汤配合低分子肝素雾化吸入治疗肺心病急性加重期的疗效及对患者血浆NT-proBNP、ET-1水平和心肺功能的影响
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摘要
目的观察麻杏五子汤配合低分子肝素雾化吸入治疗肺源性心脏病(肺心病)急性加重期的疗效及对患者血浆N末端B型脑钠肽前体(NT-proBNP)、血浆内皮素1(ET-1)水平和心肺功能的影响。方法选取2015年1月至2017年6月我院收治的肺心病急性加重期患者134例,采用随机数字表法分为观察组与对照组,每组67例。对照组患者在常规治疗的基础上给予低分子肝素雾化吸入治疗,观察组患者在对照组治疗基础上加用麻杏五子汤治疗。比较两组患者的临床疗效、血浆NT-proBNP水平、ET-1水平以及心肺功能。结果观察组患者的治疗总有效率为94.03%,对照组为80.60%,观察组患者的临床疗效显著优于对照组,差异有统计学意义(P<0.05)。治疗14 d后,两组患者的血浆NT-proBNP与ET-1水平均显著降低,观察组患者的血浆NT-proBNP与ET-1水平显著低于对照组,差异有统计学意义(P<0.01);两组患者的每搏输出量(SV)、左室射血分数(LVEF)、心输出量(CO)均显著增高,观察组患者SV、LVEF及CO均明显高于对照组,差异有统计学意义(P<0.01);两组患者的1秒用力呼吸容积(FEV1)、肺活量(FVC)及呼吸流量峰值(PEF)均显著提高,观察组患者FEV1、FVC及PEF均明显高于对照组(P<0.05)。结论麻杏五子汤配合低分子肝素雾化吸入治疗肺心病急性加重期患者可有效提高临床疗效,降低血浆NT-proBNP、ET-1水平,改善心肺功能。
Objective To observe the effect of Maxing Wuzi decoction combined with low molecular weight heparin in the treatment of acute exacerbation of pulmonary heart disease( PHD) and the effect on plasma N terminal B type natriuretic peptide precursor( NT-proBNP),plasma endothelin 1( ET-1),level and cardiopulmonary function. Methods 134 patients with acute exacerbation of PHD in our hospital from January 2015 to June 2017 were selected. They were randomly divided into observation group and control group,67 cases in each group. The control group were treated with low molecular weight heparin atomization inhalation on the basis of routine treatment,and the observation group were treated with Maxing Wuzi decoction on the basis of the control group. The clinical efficacy,plasma NT-proBNP level,ET-1 level and cardiorespiratory function were compared between the two groups. Result The total effective rate of treatment in the observation group was 94. 03%,and the control group was 80. 60%.The clinical efficacy of the observation group was significantly better than that of the control group,with a statistically significant difference( P < 0. 05). After the treatment of 14 d,the plasma levels of NT-proBNP and ET-1 in the two groups were significantly decreased. The plasma NT-proBNP and ET-1 levels of the patients in the observation group were significantly lower than those in the control group( P < 0. 01). The stroke volume( SV),left ventricular ejection fraction( LVEF) and cardiac output( CO) were significantly higher in the two groups. The SV,LVEF and CO in the observation group were significantly higher than those in the control group,the difference was statistically significant( P < 0. 01). The FEV1,FVC and PEF of the two groups were significantly improved. The FEV1,FVC and PEF of the observation group were significantly higher than those of the control group( P < 0. 05).Conclusion Maxing Wuzi decoction combined with low molecular weight heparin inhalation in the treatment of acute exacerbation of PHD patients can effectively improve the clinical effect,reduce the level of plasma NT-proBNP,ET-1,improve the heart and lung function.
Objective To observe the effect of Maxing Wuzi decoction combined with low molecular weight heparin in the treatment of acute exacerbation of pulmonary heart disease( PHD) and the effect on plasma N terminal B type natriuretic peptide precursor( NT-proBNP),plasma endothelin 1( ET-1),level and cardiopulmonary function. Methods 134 patients with acute exacerbation of PHD in our hospital from January 2015 to June 2017 were selected. They were randomly divided into observation group and control group,67 cases in each group. The control group were treated with low molecular weight heparin atomization inhalation on the basis of routine treatment,and the observation group were treated with Maxing Wuzi decoction on the basis of the control group. The clinical efficacy,plasma NT-proBNP level,ET-1 level and cardiorespiratory function were compared between the two groups. Result The total effective rate of treatment in the observation group was 94. 03%,and the control group was 80. 60%.The clinical efficacy of the observation group was significantly better than that of the control group,with a statistically significant difference( P < 0. 05). After the treatment of 14 d,the plasma levels of NT-proBNP and ET-1 in the two groups were significantly decreased. The plasma NT-proBNP and ET-1 levels of the patients in the observation group were significantly lower than those in the control group( P < 0. 01). The stroke volume( SV),left ventricular ejection fraction( LVEF) and cardiac output( CO) were significantly higher in the two groups. The SV,LVEF and CO in the observation group were significantly higher than those in the control group,the difference was statistically significant( P < 0. 01). The FEV1,FVC and PEF of the two groups were significantly improved. The FEV1,FVC and PEF of the observation group were significantly higher than those of the control group( P < 0. 05).Conclusion Maxing Wuzi decoction combined with low molecular weight heparin inhalation in the treatment of acute exacerbation of PHD patients can effectively improve the clinical effect,reduce the level of plasma NT-proBNP,ET-1,improve the heart and lung function.
引文
[1]李秋明,利桂河,杨培文.无创正压通气联合管道雾化治疗慢性阻塞性肺疾病急性加重期的临床研究[J].内科,2015,10(3):294-296.
[2]甘学军,汪小华,胡刚.低分子肝素钙皮下注射治疗慢性阻塞性肺疾病并肺心病急性加重期的临床疗效分析[J].实用心脑肺血管病杂志,2016,24(3):156-157.
[3]全国第3次肺心病专业会议.慢性肺源性心脏病急性发作期诊断标准[J].中华结核和呼吸杂志,1981,4(1):62-63.
[4]李建生,余学庆.慢性肺原性心脏病中医诊疗指南(2014版)[J].中医杂志,2014,55(6):526-531.
[5]Szummer K,Oldgren J,Lindhagen L,et al.Association between the use of fondaparinux vs low-molecular-weight heparin and clinical outcomes in patients with Non-ST-Segment elevation myocardial infarction[J].JAMA,2015,313(7):707-716.
[6]郝建军.低分子肝素钠雾化吸入在肺心病急性加重期应用效果观察[J].内科,2014,9(5):550-551,587.
[7]滕鸿,李岱,王卫彪.低分子肝素联用酚妥拉明改善肺心病急性加重期患者心肺功能的研究[J].中华全科医学,2015,13(2):210-212.
[8]殷四祥.低分子肝素钙联合氯吡格雷对肺心病急性加重期心肺功能及血液高凝状态影响[J].中外医学研究,2014,12(33):35-36.
[9]Sandner SE,Riebandt J,Haberl T,et al.Low-molecularweight heparin for anti-coagulation after left ventricular assist device implantation[J].J Heart Lung Transplant,2014,33(1):88-93.
[10]卢云,金伟,张晓云,等.中西医结合治疗肺心病急性发作期120例临床观察[J].中国临床医生,2014,42(5):71-75.
[11]吴建顺,曹得胜,李强,等.麻杏五子汤辅助治疗肺心病急性加重期(痰湿阻肺证)55例[J].中国实验方剂学杂志,2015,21(18):187-190.
[12]韦益飞,徐国良,杨华永,等.应用中心点设计法研究麻杏甘石汤有效成分的配伍关系[J].中药药理与临床,2016,32(2):13-16.
[13]汪占祥,陈聪玲,王国平,等.麻杏五子汤联合痰热清治疗肺心病急性加重期疗效[J].现代生物医学进展,2016,16(24):4712-4715.
[14]杨继雷,姚秀叶,谷伟,等.参脉注射液联合左卡尼汀对老年肺心病心力衰竭期心功能及血清Copeptin、NTpro BNP、hs-c Tn T的影响[J].疑难病杂志,2016,15(4):340-343.
[15]陈明.《伤寒论》麻杏甘石汤证再认识[J].中医杂志,2016,57(20):1785-1787.
[16]王燕青,王宁,胡海波,等.真武汤合麻杏甘石汤治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的研究[J].中国中医急症,2014,23(2):256-257,307.
[2]甘学军,汪小华,胡刚.低分子肝素钙皮下注射治疗慢性阻塞性肺疾病并肺心病急性加重期的临床疗效分析[J].实用心脑肺血管病杂志,2016,24(3):156-157.
[3]全国第3次肺心病专业会议.慢性肺源性心脏病急性发作期诊断标准[J].中华结核和呼吸杂志,1981,4(1):62-63.
[4]李建生,余学庆.慢性肺原性心脏病中医诊疗指南(2014版)[J].中医杂志,2014,55(6):526-531.
[5]Szummer K,Oldgren J,Lindhagen L,et al.Association between the use of fondaparinux vs low-molecular-weight heparin and clinical outcomes in patients with Non-ST-Segment elevation myocardial infarction[J].JAMA,2015,313(7):707-716.
[6]郝建军.低分子肝素钠雾化吸入在肺心病急性加重期应用效果观察[J].内科,2014,9(5):550-551,587.
[7]滕鸿,李岱,王卫彪.低分子肝素联用酚妥拉明改善肺心病急性加重期患者心肺功能的研究[J].中华全科医学,2015,13(2):210-212.
[8]殷四祥.低分子肝素钙联合氯吡格雷对肺心病急性加重期心肺功能及血液高凝状态影响[J].中外医学研究,2014,12(33):35-36.
[9]Sandner SE,Riebandt J,Haberl T,et al.Low-molecularweight heparin for anti-coagulation after left ventricular assist device implantation[J].J Heart Lung Transplant,2014,33(1):88-93.
[10]卢云,金伟,张晓云,等.中西医结合治疗肺心病急性发作期120例临床观察[J].中国临床医生,2014,42(5):71-75.
[11]吴建顺,曹得胜,李强,等.麻杏五子汤辅助治疗肺心病急性加重期(痰湿阻肺证)55例[J].中国实验方剂学杂志,2015,21(18):187-190.
[12]韦益飞,徐国良,杨华永,等.应用中心点设计法研究麻杏甘石汤有效成分的配伍关系[J].中药药理与临床,2016,32(2):13-16.
[13]汪占祥,陈聪玲,王国平,等.麻杏五子汤联合痰热清治疗肺心病急性加重期疗效[J].现代生物医学进展,2016,16(24):4712-4715.
[14]杨继雷,姚秀叶,谷伟,等.参脉注射液联合左卡尼汀对老年肺心病心力衰竭期心功能及血清Copeptin、NTpro BNP、hs-c Tn T的影响[J].疑难病杂志,2016,15(4):340-343.
[15]陈明.《伤寒论》麻杏甘石汤证再认识[J].中医杂志,2016,57(20):1785-1787.
[16]王燕青,王宁,胡海波,等.真武汤合麻杏甘石汤治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的研究[J].中国中医急症,2014,23(2):256-257,307.