前列地尔和硝酸甘油治疗肺心病急性加重期肺动脉高压的疗效比较

Comparison of therapeutic effects of alprostadil and nitroglycerin in the treatment of acute exacerbation pulmonary hypertension in patients with pulmonary heart disease

目的比较前列地尔和硝酸甘油治疗肺心病急性加重期肺动脉高压的疗效和安全性。方法80例慢性肺源性心脏病并肺动脉高压患者随机分为观察组（40例）和对照组（40例）。在常规治疗基础上，观察组给予前列地尔治疗，对照组给予硝酸甘油治疗。两组均连续用药14d，观察治疗前、后两组患者的临床表现及肺动脉收缩压（PASP）、动脉血氧饱和度（SaO2）、左室射血分数（LVEF）、收缩压（SBP）、舒张压（DBP）、心率（HR）的变化情况。结果观察组的显效率和总有效率显著高于对照组（X^2=4．5283、4．1142，P均〈0．05）。②治疗后观察组患者的PASP、SaO2和LVEF的改善显著高于对照组（t=2．5623、2．2881和2．3140，P均〈0．05）。③观察组治疗前后SBP、DBP和HR的波动很小（t=1．9384、1．8871和0．9030，P均〉0．05）；而对照组却有较大波动（t=6．4965、5．1730和2．1235，P〈0．01，P〈0．05）。观察组的不良反应发生率显著低于对照组（r=4．1142，P〈0．05）。结论前列地尔可降低肺心病急性发作期肺动脉高压，提高动脉血氧饱和度及左心室射血分数，疗效优于硝酸甘油，且对体循环血流动力学无明显影响，安全性好。

Objective To compare the effect and safety of alprostadil and nitroglycerin in the treatment ofacute exacerbation pulmonary hypertension in patients with pulmonary heart disease. Methods 80 patients with chronic pulmonary heart disease and pulmonary hypertension were randomly divided into two groups： the observation group （40 cases） and the control group （40 cases）, the observation group were given alprostadil and the control group was given nitroglycerin based on the conventional treatment. Continuous medication was given for 14 days in both groups. Clinical manifestations, PASP, SaO2, LVEF, SBP, DBP, HR changes of patients in both groups were observed before and after treatment. Results The significant efficiency rates and the total effective rates of the observation group were significantly higher than that of the control group （X^2=4.5283,4.1142, P〈O.05 ）. Afler treatment, the improvement of PASP, San2, LVEF of the observation group were significantly higher than that of the control group （t=2.5623,2.2881,2.3140, P all 〈0.05 ）. The fluctuations of SBP, DBP, HR in the observation group was small before and after treatment （t=1.9384,1.8871,0.9030, P〉0.05）. There was greater volatility in the control group （t=6.4965,5.1730,2.1235, P〈0.01 or P〈0.05）. The obvious side effect rates of the observation group was lower than that of the control group （X2=4.1142, P〈0.05 ）. Conclusion The alprostadil can reduce acute exacerbation of pulmonary hypertension in patients with pulmonary heart disease and improve arterial oxygen saturation and left ventricular ejection fraction, more effective than nitroglycerin, have no significant imoact withblood pressure and circulation dynamics, shows good security.