丹红注射液联合前列地尔治疗慢性阻塞性肺疾病伴肺源性心脏病并心力衰竭患者的临床疗效

Clinical Effect of Danhong Injection Combined with Alprostadil in Treating COPD Patients Complicated with Pulmonary Heart Disease and Heart Failure

目的观察丹红注射液联合前列地尔治疗慢性阻塞性肺疾病(COPD)伴肺源性心脏病并心力衰竭患者的临床疗效。方法选取2013年6月—2016年3月在青海省第五人民医院呼吸内科住院治疗的COPD伴肺源性心脏病并心力衰竭患者68例,随机分为对照组33例和试验组35例。在常规治疗基础上,对照组患者给予前列地尔治疗,试验组患者给予丹红注射液联合前列地尔治疗;两组患者均连续治疗7 d。比较两组患者临床疗效,治疗前后心功能指标[包括左心室射血分数(LVEF)、心排血量(CO)、耗氧量(VO_2)及N末端B型脑利钠肽前体(NT-proBNP)]、肺功能指标[包括第1秒用力呼气容积占预计值百分比(FEV_1%)、用力肺活量占预计值百分比(FVC%)及第1秒用力呼气容积与用力肺活量比值(FEV_1/FVC)]、肺动脉压力[包括肺动脉舒张压(PADP)、肺动脉收缩压(PASP)及平均肺动脉压(MPAP)]、血液流变学指标(包括纤维蛋白原、血小板聚集率、全血低切黏度及全血高切黏度)、血气分析指标[包括动脉血氧分压(PaO_2)及动脉血二氧化碳分压(PaCO_2)]及血清炎性因子[包括肿瘤坏死因子α(TNF-α)及白介素6(IL-6)]水平,并观察两组患者治疗期间不良反应发生情况。结果试验组患者临床疗效优于对照组(P<0.05)。治疗前两组患者LVEF、CO、VO_2、血清NT-proBNP水平及FEV_1%、FVC%、FEV_1/FVC比较,差异无统计学意义(P>0.05);治疗后试验组患者LVEF、CO及FEV_1%、FVC%、FEV_1/FVC高于对照组,VO_2及血清NT-proBNP水平低于对照组(P<0.05)。两组患者治疗前后PADP、PASP、MPAP比较,差异均无统计学意义(P>0.05)。治疗前两组患者纤维蛋白原、血小板聚集率、全血低切黏度、全血高切黏度比较,差异无统计学意义(P>0.05);治疗后试验组患者纤维蛋白原、血小板聚集率、全血低切黏度、全血高切黏度低于对照组(P<0.05)。治疗前两组患者PaO_2及PaCO_2比较,差异无统计学意义(P>0.05);治疗后试验组患者PaO_2高于对照组,PaCO_2低于对照组(P<0.05)。治疗前两组患者血清TNF-α及IL-6水平比较,差异无统计学意义(P>0.05);治疗后试验组患者血清TNF-α及IL-6水平低于对照组(P<0.05)。两组患者治疗期间均未出现严重不良反应。结论丹红注射液联合前列地尔治疗COPD伴慢性肺源性心脏病并心力衰竭患者的临床疗效确切,可有效改善患者临床症状,增强患者心肺功能,改善患者血液流变学指标及血气分析指标,降低血清炎性因子水平,且安全性较高。

Objective . To observe the clinical effect of danhong injection combined with alprostadil in treating COPD patients complicated with pulmonary heart disease and heart failure. Methods From June 2013 to March 2016, a total of 68 COPD patients complicated with pulmonary heart disease and heart failure were selected in the Department of Respiratory Medicine, the Fifth People＇s Hospital of Qinghai Province, and they were randomly divided into control group （ n =33） and testgroup （n = 35）. Based on conventional treatment, patients of control group received alprostadil, while patients nf test group received danhong injection combined with alprostadil; both groups continuously treated for 7 days. Clinical effect, index of cardiac function （including LVEF, CO, VO2 and NT-proBNP） , index of pulmonary function （including FEV1% , FVC% and FEV/FVC）, pulmonary arterial pressure （including PADP, PASP and MPAP）, index of hemorheology （including fibrinogen, platelet aggregation rate, whole blood low - shear viscosity and whole blood high - shear viscosity ） , blood - gas analysis results （including PaO2 and PaCO2 ） and serum inflammatory cytokines （including TNF-α and IL-6） levels before and after treatment were compared between the two groups, and incidence of adverse reactions during the treatment was observed. Results Clinical effect of test group was statistically significantly better than that of control group （ P 〈 0. 05）. No statistically significant differences of LVEF, CO, VO2, serum NT-proBNP level, FEV1% , FVC% or FEVJFVC was found between the two groups before treatment （P 〉 0. 05） ; after treatment, LVEF, CO, FEVj% , FVC% and FEVJFVC of test group were statistically significantly higher than those of control group, while VO2 and serum NT-proBNP level of test group were statistically significantly lower than those of control group （P 〈0. 05）. No statistically significant differences of PADP, PASP or MPAP was found between the two groups before or after treatment （P 〉 0. 05）. No statistically significant differences of fibrinogen, platelet aggregation rate, whole blood low -shear viscosity or whole blood high -shear viscosity was found between the two groups before treatment （ P 〉 0.05）, while fibrinogen, platelet aggregation rate, whole blood low - shear viscosity and whole blood high - shear viscosity of test group were statistically significantly lower than those of control group （ P 〈 0. 05 ）. No statistically significant differences of PaO2 or PaCO~ was found between the two groups before treatment （P 〉 O. 05 ） ; after treatment, PaO2 of test group was statistically significantly higher than that of control group, while PaCO2 of test group was statistically significantly lower than that of control group （P 〈0.05 ）. No statistically significant differences of serum level of TNF-α or IL-6 was found between the tw~ groups before treatment （ P 〉 0. 05 ） , while serum levels of TNF-α and IL-6 of test group were statistically significantly lower than those of control group after treatment （ P 〈 0. 05 ）. No one of the two groups occurred any severe adverse reactions during the treatment. Conclusion Danhong injection combined with alprostadil has certain clinical effect in treating COPD patients complicated with pulmonary heart disease and heart failure, can effectively relive the clinical symptoms, improve the cardiac function, pulmonary function and index of hemorheology, adjust the blood - gas results and reduce the serum inflammatory cytokines levels, and is relatively safe.