法舒地尔治疗左心疾病相关肺动脉高压的有效性及安全性研究

Efficacy and Safety of Fasudil in Treatment of the Left Heart Disease Related to Pulmonary Hypertension

目的探讨法舒地尔治疗左心疾病相关肺动脉高压（PH）的有效性及安全性。方法对我院心内科2012年1月—2014年6月住院的高血压、冠心病、心肌病等左心疾病（LHD）,NYHA心功能分级为Ⅱ级～Ⅲ级患者进行筛选,选择合并PH患者186例,随机分为试验组（92例）与对照组（94例）。两组均给予基础疾病与心力衰竭的优化治疗,试验组给予法舒地尔30 mg静脉输注,2次/日。两组疗程为2周。观察两组患者治疗前6 min步行距离、肺动脉收缩压、动脉血氧分压变化及试验组治疗前后血压、心率变化。结果治疗前两组6 min步行距离、肺动脉收缩压、动脉血氧分压比较,差异无统计学意义（P〉0.05）,治疗后试验组6 min步行距离增大,肺动脉收缩压明显下降,动脉血氧分压明显升高,且改善程度均优于对照组（P〈0.05）;试验组治疗前后血压、心率比较,差异无统计学意义（P〉0.05）,治疗前后肝肾功能、电解质无变化。进一步分析试验组中左室射血分数保留的61例患者,治疗后6 min步行距离增大,肺动脉收缩压明显下降,动脉血氧分压明显升高（P〈0.01）,而左室射血分数下降的31患者,治疗后6min步行距离增大,肺动脉收缩压下降,动脉血氧分压升高,但差异无统计学意义（P〉0.05）。结论法舒地尔可有效降低左心衰竭患者PH,改善日常活动能力,且安全有效。对左室射血分数保留的患者改善程度更为明显。

Objective To evaluate the efficacy and safety of fasudil in treatment of the left heart disease（LHD） related to pulmonary hypertension（PH）. Methods From 2012 January to 2014 June, in department of Cardiology in hospital LHD including hypertension, coronary heart disease, cardiomyopathy and NYHA classification of cardiac functionwas grade Ⅱ to Ⅳ, patients were screened. One hundred and eighty- six patients selected with PH were randomly divided into experimental group （ n = 92） treated by routine treatment plus fasudil 30 mg intravenous drip,and control group（ n = 94） treated by routine treatment for 2 weeks. Results 6 min walking distance （6MWD）, pulmonary artery systolic pressure （PASP）, arterial partial pressure of oxygen （PaO2） were observed be- fore and after the treatment. The changes of blood pressure, heart rate were observed before and after treatment in the experimental group. Results Before treatment,there was not statistically significant in 6MWD, PASP, and PaO2 between two groups （ P 〈 0. 05）. After treatment,6MWD and PaO2 increased, PASP was decreased in experimental group,and the degree of improvement was better than that in control group, the difference was statistically significant （ P 〈0. 05）. Comparison of blood pressure and heart rate of ex- perimental group before and after treatment, differences were not statistically significant（ P 〉0. 05）. Liver and kidney function, elec- trolyte had no change before and after the treatment. Further analysis, 61 patients preserved left ventricular ejection fraction（LVEF） in experimental group, after treatment, 6MWD and PaO2 increased, PASP decreased,the difference was statistically significant （ P 0. 01）. While LVEF decreased in 31 patients, after treatment, 6MWD and PaO2 increased, SPAP decreased,the difference was not statistically significant （ P 〉0. 05）. Conclusion Fasudil can effectively reduce PH in patients with left heart failure, can improve the ability of activities of daily living, and it is safe and efficient. It can improve the degree of life quality obviously in patients with LVEF retention.