硝苯地平控释片对慢性阻塞性肺疾病、肺心病的长期疗效

The long-term effect of nifedipine(control release tablets)in patients with chronic obsttructive pul-monary disease and cor pulmonale

观察硝苯地平控释剂型对慢性阻塞性肺疾病（ＣＯＰＤ）、肺心病患者的长期疗效。方法用随机、双盲有安慰剂对照的设计方法，观察了硝苯地平控释片对ＣＯＰＤ、肺心病患者［一秒钟用力呼气容积（ＦＥＶ１）／用力肺活量（ＦＶＣ）＝４７．３５％±８．１０％］的２年疗效。在２０２例患者中，硝苯地平组１０２例（２０ｍｇ／片，每日２次），安慰剂组１００例（１片每日２次）。结果二组均衡性检验有可比性。２年随访率分别为９４％和８９％。硝苯地平组与安慰剂组比较，呼吸困难、疲乏、体力活动量等症状好转者明显增多（Ｐ＜０．０５）；ＦＥＶ１和动脉血二氧化碳分压（ＰａＣＯ２）恶化不明显（Ｐ〈０．０５）；反映肺血管顺应性的肺阻抗容积图Ｂ－Ｙ１改善明显（Ｐ＜０．０５）；病死率降低（Ｐ＝０．０５１）。但某些心电图右室负荷指标（ＱＲＳ电轴右偏、Ｐ１１和ＲａＶＲ电压）恶化。结论长期服用硝苯地平控释片是一安全、方便、具有提高ＣＯＰＤ、肺心病患者生命质量，并可能减少病死率的药物，可作为ＣＯＰＤ、肺心病患者综合治疗中的一项辅助治疗。

Objective TO observe the long term effect of nifedipine(conrtol release tablets)in pa- tients with chronic obstrucve pulmonary disease and cor pulmonale.Methods A randomized,double blind,placebo controlled design was made,two hundred and two patients(FEV 1/FVC was 47.35%±8.10%)were divided into two groups:nifedipine group(20 mg Bid)102 cases,placebo group(one tablet Bid)100 cases.Results The equilibrium test between both groups was comparable.Twoyear follow up rates of both groups were 94% and 89%,respectively.The comparision of the nifedipi ne to placebo group was as follows:in nifedipine group,the improvement of dyspnea,fatigue and exerci se ca pacity showed significantly better results(P<0.05);FEV 1 and PaCO 2 deterioraion was unremarkable(P>0.05);the pulmonary impedance plethysmogram B Y Ⅰ that reflects pulmonary vascular compliance ap peared significant improvement(P<0.05)and the mortality of the disease that was the most importa ntobservation endpiont was declined(P=0.051),but some electrocardiographic index reflected right ven tricular load became worse(P