前列腺素E1联合硫酸镁在肺心病急性加重期应用中的临床研究

Clinical research about prostaglandin E1 and magnesium sulfate in the treatment of chronic pulmonary heart disease in the aggravation period.

目的探讨前列腺素E1注射液和硫酸镁注射液联用对肺心病急性加重期的临床疗效及作用机制。方法将2007年6月至2008年5月广州市红十字会医院急诊科留观室收治的53例肺心病急性加重期患者，随机分为治疗组28例、对照组25例。2组均给予低流量吸氧、祛痰止咳、抗感染、解痉平喘、强心利尿等综合治疗，治疗组在综合治疗基础上加用前列腺素E1注射液10ml、25％硫酸镁注射液10ml，疗程2周。观察2组患者治疗后I临床症状改善状况及治疗前后血气分析的改变。结果2组患者临床疗效总有效率分别为89．3％（25／28）和76．0％（18／25），治疗组疗效优于对照组（χ^2=1．87，P〈0．05）；治疗组治疗前PaO2（8．36±2．28）kPa、PaCO2（9．31±3．41）kPa、全血黏度（12．12±0．45）mPa、纤维蛋白原（5．32±1．16）g/L，对照组治疗前PaO2（8.27±1．92）kPa、PaCO2（9．43±2．82）kPa、全血黏度（12．32±0．52）mPa·s、纤维蛋白原（5．18±1．23）g/L；治疗组治疗后PaO2（10．52±2．12）kPa、PaCO2（7．63±1．62）kPa、全血黏度（7．42±0．36）mPa、纤维蛋白原（3．21±0．97）g／L，对照组治疗后PaO2（9．15±1．83）kPa，PaCO2（8．54±1．67）kPa、全血黏度（11．92±0．31）mPa·s、纤维蛋白原（4．76±2．14）g/L；2组患者治疗后PaO2、PaCO2、全血黏度及纤维蛋白原均有改善（P均〈0．05），但治疗组血气分析各项观察指标的改善优于对照组（P均〈0．05）。结论前列腺素E1注射液和硫酸镁注射液联用，能降低肺动脉压，减轻右心室后负荷，扩张气管平滑肌、改善通气障碍，可改善肺心病急性加重期的PaO2、PaCO2，对肺心病急性加重期有较好的临床疗效。

Objective To study the curative effect and medchanism of action about prostaglandin E1 and magnesium sulfate in the treatment of chronic pulmonary heart disease in the aggravation period . Methods Fiftythree patients with chronic pulmonary heart disease in the aggravation period were accepted emergencyward in the Guangzhoa Red Cross Hospital during Jane 2007 to May 2008, they were randomly divided into the treatment group （28 case） and control group （25 case） . Both groups were given low flux breathe in oxygen and dissipate phlegm and relieve a cough and resist infection and spasmolysis and calm down asthma and strive heart and diuresis colligate therapy . Mean while, patients in the treatment group, beside the colligate therapy,were treated with prostaglandin E1 10 ml and magnesium sulfate 10 ml,the course of treatment lasted 2 weeks . Then we investigate the amelioration of clinical symptom and alteration of blood gas analysis in the two groups before and after the treatment. Results The rate of clinical efficacy were 89.3% （25/28） and 76.0% （18/25） ,with superiority in the treatment group （χ^2 = 1.87,P 〈 0.05） . Whole blood viscosity,fibrinogen, PaO2 and PaCO2 were improved in both groups,amelioration of blood gas analysis observation superiority in the treatment group compared with control group （ P 〈 0.05 ）. Conclusions Prostaglandin E1 and magnesium sulfate can depress pulmonary artery pressure and abate the afterload of right ventricle ,which have better treatment effect in chronic pulmonary heart disease in the aggravation period.