低分子肝素联合酚妥拉明治疗老年肺源性心脏病临床评价

Clinical Evaluation of Low Molecular Weight Heparin Combined with Phentolamine in the Treatment of Elderly Patients with Pulmonary Heart Disease

目的探讨低分子肝素联合酚妥拉明治疗老年肺源性心脏病(简称肺心病)的临床疗效,以及对患者心肺功能和一氧化氮(NO)、内皮素-1(ET-1)水平的影响。方法选取荣昌区人民医院2017年5月至2020年5月收治的老年肺心病患者80例,按随机数字表法分为观察组和对照组,各40例。两组均予抗感染、持续氧疗、吸痰等常规治疗,并予甲磺酸酚妥拉明注射液静脉滴注,观察组患者加用低分子量肝素钙注射液皮下注射。两组均以10 d为1个疗程,持续治疗3个疗程。结果观察组总有效率为90.00%,显著高于对照组的72.50%(P<0.05);治疗后,两组患者的右心室射血分数(RVEF)、第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%),以及FEV_(1)/用力肺活量(FVC)和NO水平均较治疗前显著升高(P<0.05),肺动脉收缩压(PASP)及ET-1水平均较治疗前显著降低(P<0.05),且观察组上述指标改善程度均显著优于对照组(P<0.05);观察组与对照组不良反应发生率相当(P>0.05)。结论低分子肝素联合酚妥拉明治疗老年肺心病,可明显改善患者的心肺功能及NO和ET-1水平。

Objective To investigate the clinical efficacy of low molecular weight heparin combined with phentolamine in the treatment of elderly patients with pulmonary heart disease,and its effect on cardiopulmonary function,the levels of nitric oxide(NO)and endothelin-1(ET-1).Methods Totally 80 elderly patients with pulmonary heart disease admitted to Rongchang District People’s Hospital from May 2017 to May 2020 were selected and randomly divided into the observation group and the control group,40 cases in each group.The patients in the two groups were given routine treatment such as anti-infection,continuous oxygen therapy,sputum suction,and intravenous drip of Phentolamine Mesylate Injection.On this basis,the patients in the observation group were given subcutaneous injection of Low Molecular Weight Heparin Calcium Injection.Both groups were continuously treated for three courses with 10 d as a course of treatment.Results The total effective rate of the observation group was 90.00%,which was significantly higher than 72.50%of the control group(P<0.05).After treatment,the right ventricular ejection fraction(RVEF),the percentage of forced expiratory volume in the first second(FEV1%),FEV_(1)/forced vital capacity(FVC)and NO level in the two groups were significantly higher than those before treatment(P<0.05),while the pulmonary artery systolic pressure(PASP)and ET-1 levels in the two groups were significantly lower than those before treatment(P<0.01),and the improvement of above indexes in the observation group were significantly better than those in the control group(P<0.05).The incidence of adverse reactions in the observation group was similar to that in the control group(P>0.05).Conclusion Low molecular weight heparin combined with phentolamine in the treatment of elderly patients with pulmonary heart disease can significantly improve the cardiopulmonary function and the levels of NO and ET-1.