酚妥拉明联合地尔硫对慢性肺心病急性加重期肺动脉高压的疗效观察

Effect of phentolamine and diltiazem on pulmonary artery hypertension in exacerbations of chronic obstructive pulmonary disease patients with chronic cor pulmonale

目的观察酚妥拉明联合地尔硫对慢性肺源性心脏病患者急性加重期肺动脉高压的影响。方法对照组35例,给予常规治疗;酚妥拉明组30例,给予酚妥拉明10 mg微量泵持续静脉泵入,速度0.4～0.6 mg/h;地尔硫组30例,给予口服地尔硫30 mg,3次/d;联合治疗组30例,给予酚妥拉明10 mg微量泵静脉泵入,同时给予口服地尔硫30 mg,3次/d;疗程为14天。观察治疗前后各组及组间平均肺动脉压力(mPAP)和血浆脑钠肽(BNP)的变化。结果各组治疗后较治疗前相比mPAP、BNP均显著降低,常规治疗组mPAP(55.2±6.5)mmHg vs(48.6±8.2)mmHg(P<0.05),BNP(602.9±96.6)pg/L vs(416.2±43.7)pg/L(P<0.05);酚妥拉明组mPAP(57.3±6.8)mmHg vs(42.1±9.6)mmHg(P<0.05),BNP(628.2±89.1)pg/L vs(356.1±37.9)pg/L(P<0.01);地尔硫组(56.2±6.1)mmHg vs(43.4±8.9)mmHg(P<0.05),BNP(612.7±87.4)pg/L vs(382.9±37.5)pg/L(P<0.01);联合治疗组mPAP(58.3±6.7)mmHg vs(30.5±7.7)mmHg(P<0.01),BNP(644.6±98.3)pg/L vs(286.5±33.4)pg/L(P<0.01)。联合治疗组mPAP、BNP较其他治疗组下降更明显(P<0.05或<0.01)。结论酚妥拉明联合地尔硫能显著降低慢性肺源性心脏病患者急性加重期BNP水平及肺动脉压力。

Objective To evaluate the effects of phentolamine and diltiazem on pulmonary artery hypertension in exacerbations of patients with chronic cor pulmonale caused by chronic obstructive pulmonary disease（COPD）.Methods One hundred and twenty-five patients with COPD compicated with cor pulmonale were randomly divided into routine group（n=35）,phentolamine group（n=30）,diltiazem group（n=30） and phentolamine＋ diltiazem group（n=30）.Four groups were given routine treatment and phentolamine group was given phentolamine（10 mg） intravenous infusion by micro pump（0.4-0.6 mg/h）,diltiazem group was given oral diltiazem supplement（30 mg,three times a day）,phentolamine＋ diltiazem group was given phentolamine（10 mg） intravenous infusion by micro pump and oral diltiazem supplement（30 mg,three times a day）.Change of brain natriuretic peptide（BNP） and mean artery pulmonary artery pressure（mPAP） after 14 days were measured.Results In treatment groups,BNP and mean pulmonary artery pressure decreased significantly after 14 days of treatment compared with those before treatment in the same group and routine group（all P0.05）.mPAP in routine group（55.2±6.5）mmHg vs（48.6±8.2） mmHg（P0.05）,BNP（602.9±96.6） pg/L vs（416.2±43.7） pg/L（P0.05）;mPAP in phentolamine group（57.3±6.8） mmHg vs（42.1±9.6） mmHg（P0.05）,BNP（628.2±89.1） pg/L vs（356.1±37.9） pg/L（P0.01）;mPAP in diltiazem group（56.2±6.1） mmHg vs（43.4±8.9） mmHg（P0.05）,BNP（612.7±87.4） pg/L vs（382.9±37.5） pg/L（P0.01）;mPAP in phentolamine＋diltiazem group（58.3±6.7） mmHg vs（30.5±7.7） mmHg（P0.01）,BNP（644.6±98.3） pg/L vs（286.5±33.4） pg/L（P0.01）.Further extremely significant downregulation of BNP expression and mean pulmonary artery pressure were observed in phentolamine and diltiazem group after the following 14 days′ treatment.Conclusion Phentolamine and diltiazem can adjust the synthesis and secretion of BNP,and the treatment can efficiently decrease pulmonary artery pressure.