螺内酯对慢性肺原性心脏病心肺功能作用观察

Therapeutic effects of spirono lactone on cardiac and pulmonary function of chronic pulmonary heart disease

目的通过随机的螺内酯评价研究试验,讨论螺内酯对慢性肺原性心脏病患者右心功能和肺功能的影响,并探究其可能的机制。方法选择符合肺原性心脏病诊断标准的患者150例,将150例患者随机分为2组;螺内酯组80例,对照组70例。治疗前及治疗后6个月分别检测以下指标:患者右室流出道内径、右心室内径、右肺动脉内径、用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、最大呼气流量(PEF)及3个月及6个月的血钾变化。结果螺内酯治疗后,右室流出道内径、右心室内径、右肺动脉内径与治疗前有显著差异(P<0.05),治疗后两组FEV1及PEF的改善有显著差异性(P<0.05)。结论小剂量螺内酯治疗慢性肺原性心脏病,可改善患者心肺功能,显著降低死亡率,对血钾浓度无影响。

OBJECTIVE To better understand the therapeutic effects and explore the possibly roles of spironolactone on right cardiac and pulmonary function of chroni Cpulmonary heart disease（PHD） using the randomized aldactone evaluation study（RALES）.METHODS One hundred and fifty patients with PHD according to therevised 1997 standard diagnostic criteria of Chronic pulmonary heart disease,wereselected from February 2004 to February 2008 in our hospital.All patients were randomly divided into two groups：80 patients with spironolactone treatmentand 70 patients without spironolactone treatment as control.Three following items were evaluated for each patient in six moths before and after spironolactone treatment：1）determination of interior dimeter of right ventricular outflow tract,right ventriculus dexter and right pulmonary artery by color doppler echocardiography（PHILPS HDI-500）;2）examination of forced vital capacity（FVC）,forced expiratory volumein one second（FEV1）and peak expiratory flow（PEF）by pulmonary function automatic apparatus（Jaeger,Germany）;3）measurement of changes of serum potassium levels in 3 months,6 months before and after spironolactone treatment.RESULTS The size of interior diameter of right ventricular outflow.tract,rightventriculus dexter and right pulmonary artery had signiflcant smaller inspironolactone treatment group after six months follow-up period compared to thattreated before（P〈0.05）;and spironolactone treatment had improvement at significant levels in FEV1 and PEF between these two groups（P〈0.05）.However,there was no statistically difference in serum potassium levels（P〉0.05）.CONCLUSION A smallmount of spironolactone（20mg,BID）has a substantially improvement in cardiac and pulmonary function of patients with PHD and has a significant reduce in mortality.Our results are in accordance with previous reports.