血必净、酚妥拉明联合多巴胺治疗慢性阻塞性肺疾病急性加重期并发多脏器功能衰竭的临床研究

Combined Treatment of Xuebijing Injection,Phentolamine and Dopamine on Patients with Acute Exacerbated Chronic Obstructive Pulmonary Disease and Multiple-Organ Failure

目的探讨血必净、酚妥拉明、多巴胺联合治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发多脏器功能衰竭的临床效果。方法选取2011年7月至2014年7月河北省民政总医院收治的AECOPD并发多脏器功能衰竭患者150例,按照随机数字表法分为对照组、观察A组和观察B组,每组50例。患者均接受常规治疗,观察A组在常规治疗的基础上加用5%葡萄糖200 m L+酚妥拉明10 mg+多巴胺20 mg,静脉滴注;观察B组在常规治疗基础上,加用血必净100 m L每日2次静脉滴注,联合5%葡萄糖200 m L+酚妥拉明(10 mg)+多巴胺(20 mg),静脉滴注。治疗周期为15 d。比较三组的临床疗效及治疗前后炎症指标[外周血白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)],凝血功能指标[血浆D-二聚体、血小板计数(PLT)、纤维蛋白原(Fib)]及心功能指标[左心室射血分数(LVEF)]。结果对照组、观察A组和观察B组总有效率分别为42.0%(21/50)、62.0%(31/50)和80.0%(40/50),三组临床疗效比较差异有统计学意义(P<0.05),且观察B组总有效率高于对照组和观察A组(P<0.05)。治疗后观察B组患者WBC、CRP及PCT水平分别为(10.0±3.1)×109/L、(20±6)mg/L、(0.23±0.11)μg/L,且显著低于对照组[(17.2±5.8)×109/L、(61±8)mg/L、(0.71±0.19)μg/L]和观察A组[(17.6±2.2)×109/L、(61±9)mg/L、(0.69±0.27)μg/L],差异均有统计学意义(P<0.05)。治疗后三组患者PLT和LVEF水平显著上升,Fib及D-二聚体水平均显著下降;观察A组PLT和LVEF水平为(160±45)×109/L、(57±5%),观察B组分别为(201±50)×109/L、(61±5)%,均显著高于对照组[(138±36)×109/L、(54±4)%],且观察B组显著高于观察A组,差异有统计学意义(P<0.05);观察A组Fib、D-二聚体水平为(3.9±0.9)g/L、(1.2±0.8)mg/L,观察B组分别为(3.2±1.0)g/L、(0.7±0.2)mg/L,均显著低于对照组[(4.4±0.9)g/L、(1.6±0.6)mg/L],且观察B组显著低于观察A组,差异有统计学意义(P<0.05)。结论常规治疗基础上,加用血必净+酚妥拉明+多巴胺治疗AECOPD并发多脏器功能衰竭,能快速有效地改善患者炎症、凝血功能及心脏功能,疗效显著,优于单用酚妥拉明+多巴胺联合常规疗法,值得推荐。

Objective To investigate the effect of combined treatment of Xuebijing injection,phentolamine and dopamine on patients with acute exacerbated chronic obstructive pulmonary disease（ AECOPD） and multipleorgan failure. Methods Total of 150 patients with AECOPD and multiple-organ failure were randomly divided into control group,observation group A and observation group B,50 cases in each group. All patients were administrated with conventional treatment. On the basis of conventional therapy,observation A group was given 5% glucose 200 m L ＋ phentolamine 10 mg ＋ dopamine 20 mg,intravenous infusion; observation group B was given Xuebijing 100 m L,intravenous dripping,two times daily ＋ 5% glucose 200 m L ＋ phentolamine（ 10 mg） ＋ dopamine（ 20 mg）,intravenous drip. The treatment cycle was 15 days. The clinical curative effect of the three groups and the inflammatory indexes of peripheral blood,peripheral blood white blood cell count（ WBC）,C-reactive protein（ CRP）,procalcitonin（ PCT）,and coagulation function indexes[plasma D-dimer,platelet count（ PLT）,fibrinogen（ Fib） ]and left ventricular ejection fraction（ LVEF） of the three groups were compared. Results The total effective rate of the control group,observation group A and observation group B were 42. 0%（ 21 /50）,62. 0%（ 31 /50）,80. 0%（ 40 /50）,and the total effective rate of group B was higher than the control group and group A（ P 〈0. 05）. The level of WBC,CRP and PCT of observation group B significantly decreased to（ 10. 0 ± 3. 1） × 109/ L,（ 20 ±6） mg/L,（ 0. 23 ± 0. 11） μg/L after treatment. The level of WBC,CRP and PCT of observation group B were significantly lower than the control group[（ 17. 2 ± 5. 8） × 109/ L,（ 61 ± 8） mg / L,（ 0. 71 ± 0. 19） μg / L]and observation group A [（ 17. 6 ± 2. 2） × 109/ L,（ 61 ± 9） mg / L,（ 0. 69 ± 0. 27） μg / L]（ P 〈0. 05）. After treatment,the PLT and LVEF level significantly increased,while D-dimer and Fib significantly decreased（ P 〈0. 05）The level of PLT and LVEF of observation group A and observation group B[（ 160 ± 45） × 109/ L,（ 57 ± 5） %;（ 201 ±50） ×109/ L,（ 61 ± 5） %] were significantly higher than the control group[（ 138 ± 36） × 109/ L,（ 54 ±4） % ],and group B was significantly higher than group AP 〈0. 05）; the level of Fib and D-dimer of observation group A and observation group B [（ 3. 9 ± 0. 9） g / L,（ 1. 2 ± 0. 8） mg / L;（ 3. 2 ± 1. 0） g / L,（ 0. 7 ± 0. 2） mg / L]were significantly lower than he control group[（ 4. 4 ± 0. 9） g / L,（ 1. 6 ± 0. 6） mg / L],and group B was significantly lower than group A（ P 〈0. 05）. Conclusion Based on conventional treatment,combined treatment of Xuebijing injection,phentolamine and dopamine on patients with AECOPD and multiple-organ failure can significantly improve inflammatory condition,coagulation function and heart function of the patients,with significant effect and is better than the therapy of phentolamine and dopamine only,thus is worthy of recommendation in clinical practice.