螺内酯联合血管紧张素转换酶抑制剂治疗重度慢性阻塞性肺疾病合并慢性肺源性心脏病疗效分析

Efficacy Analysis of Spironolactone Combined with Angiotensin Converting Enzyme Inhibitors in the Treatment of Severe Chronic Obstructive Pulmonary Disease Combined with Chronic Pulmonary Heart Disease

目的探讨螺内酯联合血管紧张素转换酶抑制剂(ACEI)治疗重度慢性阻塞性肺疾病(COPD)合并慢性肺源性心脏病(简称肺心病)的疗效。方法选择重度COPD合并肺心病患者84例,将其随机分为螺内酯组和常规组。常规组使用贝那普利片、呋塞米片、地高辛片治疗;螺内酯组在常规组治疗的基础上加用螺内酯片治疗,疗程均为4周。观察两组疗效,治疗前后肺功能:用力肺活量(FVC)占预计值百分比(FVC%),1s用力呼气末容积(FEV1)占预计值百分比(FEV1%),FEV1/FVC;血压、心率情况。结果螺内酯组疗效优于常规组,差异有统计学意义(P<0.05)。螺内酯组肺功能改善优于常规组,差异有统计学意义(P<0.05)。治疗后两组血压比较,差异无统计学意义(P>0.05);治疗后两组心率比较,差异有统计学意义(P<0.05)。结论应用螺内酯可在普通心力衰竭治疗的基础上增加对重度COPD合并肺心病的疗效,改善肺功能,对血压影响小,可减慢心率,使患者获益,值得推广。

Objective To explore the clinical effects of the combination of spironolactone and angiotensin - converting enzyme inhibitors （ACEI） for severe chronic obstructive pulmonary disease （COPD） combined with chronic pulmonary heart disease （cor pulmonale）. Methods 84 patients with severe COPD combined with chronic pulmonary heart disease were elected in random. They were randomly divided into spironolactone group and conventional group. The conventional group with benazepril hydroehloride tablets, furosemide tablets, digoxin tablets treatment; spironolaetone group treated with spironolactone tablets based on routine treatment group, treatment for 4 weeks. The effect of two groups were observed before and after treatment, pulmonary function： forced vital capacity （FVC）% predicted （FVC%）, ls forced expiratory volume （FEV1）% predicted （FEV1 % ） , FEVI/FVC, blood pressure and heart rate. Results Spironolactone group is better than the conventional group, the difference was statistically significant （P 〈0. 05）. Lung function improved spironolaetone group is superior to control group, the difference was statistically significant （ P 〈 0.05）. Comparison of blood pressure of the two groups after treatment, no significant difference （ P 〉 0. 05 ） ; heart rate after treatment were compared between the two groups, the difference was statistically significant （P 〈 0. 05）. Conclusion Treatment with spironolaetone on the basis of the general treatment of heart failure may increase the efficiency of severe COPD combined with chronic pulmonary heart disease, improvement in lung function, less impact on blood pressure, can slow down the heart rate, from which patients benefit, hence, it is worth promoting.