几种抗心律失常药物治疗老年慢性肺心病右心衰血流动力学效应比较

HAEMODYNAMIC COMPARISON OF SEVERAL MEDICINES FOR TREATMENT OF RIGHT HEART FAILURE OF OLD CHRONIC PULMONARY HEART DISEASE

应用硝普纳(简称NP),1,6-二磷酸果糖(简称FDP)及氨力农(简称Amr)三种抗心衰药物分别治疗老年慢性肺心病右心衰各10例,并进行临床疗效及血流动力学效应比较。结果显示,三者对老年慢性肺心病右心衰有相同的血流动力学效应:降低MAP、MRVP、MPAP、及PCWP,提高CI,且都能不同程度地改善临床症状及心功能。但因三者药理作用机理不同,其血流动力学的特点亦有所不同:NP降低MAP、MRVP、MPAP、PVR及SVR的作用非常显著,而降低PCWP,增加CI的作用则不及FDP;FDP降低PCWP,增加CI最为显著,对MAP、MRVP、MPAP、PVR及SVR也有降低作用,但程度不及NP;Amr降低PCWP,增加CI的作用较NP为强,较FDP为弱,处于二者之间,而降低MAP、MRVP、MPAP、PVR及SVR的作用为三者中最弱。著者意见:宜根据老年慢性肺心病右心衰血流动力学表现特点选择用药,如MAP、MRVP、MPAP、PVR及SVR明显增高者可选用NP;如PCWP明显增高,CI较低者可选用Amr;二者均有可选用FDP。

Three medicines-nitroprusside(NP), 1, 6 -fructose diphosphate (FDP) and amri- none(Amr), were used for the treatment of 30 cases with right heart failure of old chronic pulmonary heart disease in this article. The results showed that the manifestations of haemodynamics of these medicines were similar, such as decreasing MAP, MRVP, MPAP and PCWP, increasing CI and improving the clinical symptoms and heart function. But their pharmacological mechanism and haemody-namic characteristics were different from one another. For example, the effects of NP on decreasing MAP, MRVP, MPAP, PVP and SVR were very strong, but not so strong as FDP on decreasing PCWP and increasing CI; FDP also had effects on decreasing MAP, MRVP, MPAP, PVR and SVR, but not so strong as NP ; the effects of Amr on decreasing PCWP and increasing CI were between those of NP and FDP and it had least effects on decteasing MAP, MRVP, MPAP, PVR and SVR among three medicines. In conclusion, different medicines should be chosen according to their haemodynamic characteristics during the treatment of right herat failure of old chronic pulmonary heart disease.