美托洛尔联合乌司他丁治疗慢性阻塞性肺疾病合并慢性心力衰竭的临床观察

Clinical effects of metoprolol combine with ulinastation on patients with chronic obstructive pulmonary disease complicated with chronic heart failure

目的:探讨美托洛尔联合乌司他丁治疗慢性阻塞性肺疾病(COPD)合并慢性心力衰竭(CHF)的临床疗效。方法:选取2014年1月至2015年12月收治的COPD合并CHF患者80例,将其随机分为观察组和对照组,每组40例。两组患者均给予常规治疗,对照组加用美托洛尔治疗,观察组加用美托洛尔联合乌司他丁治疗。观察两组患者临床疗效、治疗前及治疗后的肺功能指标变化以及不良反应发生情况,并采用St.George's呼吸疾病问卷(SGRQ)评分评价两组患者的生活质量。结果:观察组治疗总有效率为87.5%,显著高于对照组的75.0%,但差异无统计学意义(P>0.05)。两组治疗前肺功能指标[1s用力呼气容积(FEV1)、FEV1与预测值的比值(FEV1/pred)及FEV1与用力肺活量(FVC)的比值]比较,差异均无统计学意义(均P>0.05);治疗4个月后,观察组的FEV1为(1.51±0.42)L,FEV1/FVC为(66.08±10.11)%,FEV1/pred为(51.38±5.67)%,分别高于对照组的(1.33±0.42)L、(57.88±7.08)%、(46.33±5.15)%,且差异具有统计学意义(P<0.05)。治疗7个月后,观察组患者的SGRQ评分低于对照组,且差异具有统计学意义(P<0.05)。两组均未出现明显的肾功能异常等严重并发症和不良反应。结论:美托洛尔联合乌司他丁治疗COPD合并CHF疗效确切,能够改善患者的生活质量,未明显降低患者肺功能,安全性高,值得临床推广应用。

Objective： To investigate the clinical efficacy o{ metoprolol combined with ulinastation on the pa- tients with chronic obstructive pulmonary disease （COPD） complicated with chronic heart failure （CHF）. Methods： 80 patients with COPD complicated with CHF in our hospital from January 2014 to December 2015 were selected and divided into a control group （ n =40） and an observation group （ n =40）. The pa- tients in the control group received routine treatment with the addition of metoprolola, while those in the observation group were treated as the control group with the addition of ulinastatin. The clinical efficacy, lung function, life quality and adverse reactions were compared between the two groups. Results： The total response rate in the observation group （87.5%） was higher than that in the control group （75.0%） （ P 〉 0. 05）. Before treatment, there were no significant differences in the forced expiratory volume in 1 sec. （FEV1）, the ratio of FEV1 and forced vital capacity （FVC）, the ratio of FEV1 and predictive value be- tween the two groups （ P〉0.05）. After 4-month treatment, the FEV1 was （1.51±0.42） L, the FEV1/ FVC ratio was （66.08± 10.11）% and the FEV1/pred ratio was （51.38 ± 5.67）%in the observation group, and were respectively （1.33±0.42）L, （57.88±7.08）% and （46.33±5.15）% in the control group. The three lung-function indicators （FEV1, FEV1/FVCand FEV1/pred ） in the two groups were statistically different （ P〈0.05）. After 7-monthtreatment, the St George＇s respiratory questionnaire scores in the observation group was lower than those in the control group （ P〉0.05）. No severe complications and adverse reactions occurred in both groups. Conclusion. Metoprolol combined with ulinastation achieved a better effect for treating COPD complicated with CHF, which could improve patients＂ life quality and did not obviously influence their lung function.