左卡尼汀应用于慢性肺源性心脏病患者急性加重期的疗效观察

Clinical Observation of Levocarnitine Used for Acute Exacerbation of Chronic Pulmonary Heart Disease

目的观察左卡尼汀应用于慢性肺源性心脏病患者急性加重期的治疗效果。方法将2011年10月至2012年12月在潍坊市坊子区人民医院呼吸科治疗的78例慢性肺源性心脏病急性加重住院患者,随机分为观察组43例和对照组35例。对照组采用抗感染、改善通气、强心、利尿等常规治疗;观察组在常规治疗基础上,加用左卡尼汀注射液2 g,溶于5%葡萄糖溶液50 mL中,于12 h内用静脉泵持续泵入,每日2次。治疗10 d后,将心肺功能症状改善状况,治疗后的动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、肺动脉平均压(mPAP)、右心室射血分数(RVEF)变化与对照组比较。结果观察组患者治疗后心肺功能改善状况(显效27例,好转14例,无效2例)与对照组患者(显效16例,好转15例,无效4例)比较,差异有统计学意义(Z c=5.9351,P<0.05);治疗后观察组患者PaO2、PaCO2、mPAP、RVEF的数值分别为(75.5±7.2)mm Hg、(40.5±8.6)mm Hg、(30.1±3.7)mm Hg、(41.5±7.9)%,对照组为(66.8±7.7)mm Hg、(44.9±8.5)mm Hg、(33.8±3.9)mm Hg、(37.1±8.6)%,二者比较差异有统计学意义(P<0.05)。结论在抗感染、改善通气、强心、利尿等常规治疗基础上加用左卡尼汀,可显著提高慢性肺源性心脏病患者急性加重期的治疗效果。

Objective To observe the therapeutic effect of levocarnitine used for patients with acute exacerbation of chronic pulmonary heart disease.Methods Seventy-eight cases with acute exacerbation of chronic pulmonary heart disease which were treated in Department of Respiration of Fangzi District People＇s Hospital from October 2011 to December 2012,were randomly divided into the observation group of 43 cases and the control group of 35 cases.The control group was treated with anti-infective,improving ventilation,enhancing power of cardiac muscle systole,diuresis,and other conventional treatments.Levocarnitine injection 2 g dissolved in 50 mL of 5% glucose solution was injected intravenously with medical pump in 12 hours,2 times a day for observation group,on the basis of conventional therapy.After 10 days of treatment,the changes of cardiopulmonary status,arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide,mean pulmonary arterial pressure,right ventricular ejection fraction of the two groups were collected and compared.Results Cardiopulmonary status of the observation group after 10 days treatment（27 cases had marked effect,improvement in 14 cases,2 cases were invalid）,was better than the control group patients＇（16 cases had marked effect,improvement in 15 cases,4 cases were invalid）（P 0.05）.After 10 days treatment,the observation group patients＇ numerical value of PaO 2,PaCO 2,mPAP and RVEF were（75.5 ±7.2） mm Hg,（40.5 ± 8.6） mm Hg,（30.1 ± 3.7） mm Hg,（41.5 ± 7.9） %,which were superior to that in the control group patients＇ ：（66.8 ± 7.7） mm Hg,（44.9 ± 8.5） mm Hg,（33.8 ± 3.9） mm Hg,（37.1 ± 8.6） %.The differences were statistically significance（P 0.05）.Conclusion Application of levocarnitine on the basis of conventional anti-infection,ventilation improving,cardiac,diuretic treatment can significantly improve the therapeutic effect of patients with acute exacerbation of chronic pulmonary heart disease.