比索洛尔联合法舒地尔治疗慢性阻塞性肺疾病并肺心病急性加重期的疗效及对肺动脉高压的影响

The effectiveness of bisoprolol combined with fasudil on chronic obstructive pulmonary disease combined with acute exacerbation of pulmonary heart disease and its influence on pulmonary hypertension

目的:探讨比索洛尔联合法舒地尔治疗慢性阻塞性肺疾病(COPD)并肺心病(PHD)急性加重期的临床疗效及对肺动脉高压(PAH)的影响。方法:将108例COPD后继发PHD急性加重期患者按随机数字表法分为两组:对照组(n=54)给予比索洛尔联合常规治疗,观察组(n=54)在对照组治疗基础上加用法舒地尔治疗。测定两组患者治疗前、后动脉血气分析指标[二氧化碳分压(PaCO_2)、氧分压(PaO_2)]、氧动力学指标[氧输送指数(DO_2I)、氧消耗指数(VO_2I)及肺内分流率(Qs/Qt)]、肺功能指标[第1s用力呼气容积占预计值的百分比(FEV1%)、用力肺活量占预计值的百分比(FVC%)、FEV1/FVC]、心功能指标[心率(HR)、右室射血分数(RVEF)、心脏指数(CI)、右室作功指数(RWI)、右室压(RVP)、右心室舒张期容积(RVEDV)]、血流动力学参数[中心静脉压(CVP)、平均肺动脉压(mPAP)、肺血管阻力指数(PVRI)、肺动脉嵌顿压(PAWP)]和6min步行试验(6MWD),并比较分析两组疗效差异。结果:治疗后,观察组总有效率为94.44%,显著高于对照组的79.63%(P<0.05);在动脉血气指标、氧动力学指标、肺功能指标、6MWD及血流动力学参数中,观察组各指标改善均显著优于对照组(均P<0.05);观察组RVEF、CI显著高于对照组,RWI、RVP及RVEDV显著低于对照组(P<0.05),两组HR无明显差异(P>0.05)。结论:比索洛尔联合法舒地尔治疗COPD合并PHD急性加重期的疗效确切,能改善心、肺功能,并有效控制PAH。

Objective：To investigate the effectiveness of bisoprolol combined with fasudil on chronic obstructive pulmonary disease（COPD）combined with acute exacerbation of pulmonary heart disease（PHD）and its influence on pulmonary hypertension（PAH）.Methods：A total of 108 patients with COPD complicated with acute exacerbation of PHD in our hospital were selected,and randomly divided into two groups：a control group（n=54）in which the patients received conventional therapy and bisoprolol,and an observation group（n=54）in which the patients were treated as the control group with addition of fasudil.The partial pressure of carbon dioxide（PaCO2）,partial pressure of oxygen（PaO2）,O2 transport index（DO2 I）,O2 consumption index（VO2 I）,Qs/Qt shunt rate（Qs/Qt）,1 sforced expiratory volume percentage of predicted value（FEV1%）,FVC% predicted lung function percentage（FVC%）,FEV1/FVC,heart rate（HR）,right ventricular ejection fraction（RVEF）,ardiac index（CI）,right ventricular pressure（RVP）,right ventricular end-diastolic volume（RVEDV）,central venous pressure（CVP）,mean pulmonary arterial pressure（mPAP）,pulmonary vascular resistance index（PVRI）,pulmonary artery wedge pressure（PAWP）and 6 min walking distance（6 MWD）were evaluated before and after treatment.Results：The total effective rate in the observation group was 94.44%,which was significantly higher than that in the control group（79.63%）（P〈0.05）.After treatment,the arterial blood gas indexes,oxygen dynamic indexes,lung function indexes,6 MWD and hemodynamics parameters in the observation group were significantly better than those in the control group（P〈0.05）.The RVEF and CI in the observation group were significantly higher than those in the control group,while the RWI,RVP and RVEDV were significantly lower（P〈0.05）.No significant difference was noted in the HR between the two groups（P〉0.05）.Conclusion：Bisoprolol combined with fasudil was effective for COPD complicated with PHD.It could improve the heart and lung function,and control PAH.