贝前列素钠联合米力农对左心疾病相关性肺动脉高压的疗效观察

Clinical observation of beprostol sodium combined with milrinone in treatment of pulmonary hypertension associated with left heart disease.

目的观察贝前列素钠联合米力农对左心疾病相关性肺动脉高压(PH-LHD)的临床疗效。方法将2019年1月2021年1月收治的PH-LHD患者184例随机分为4组,每组46例。常规治疗组给予吸氧、抗凝、利尿及强心等对症治疗;贝前列素钠组在常规治疗基础上加用口服贝前列素钠;米力农组在常规治疗基础上经静脉加用米力农;联合组在常规治疗基础上同时加用贝前列素钠和米力农。观察4组治疗前后脑钠尿肽(BNP)、动脉血氧分压(PO2)、肺动脉收缩压(PASP)、左室射血分数(LVEF)、6分钟步行距离(6MWD)和WHO肺动脉高压功能分级(WHO-FC)的变化和不良反应。结果治疗72 h时后,4组BNP均较治疗前显著降低(均P<0.05),而与常规组及贝前列素钠组相比,米力农组及联合组下降更显著(分别P<0.05, P<0.01)。治疗72 h后,米力农组和联合组HR明显较前两组患者增高(均P<0.01)。治疗12周后,4组患者BNP和HR均较治疗前下降(P<0.01),但组间差异无统计学意义。4组住院天数的比较,联合组住院天数较常规组和贝前列素钠组显著减少(P<0.01),较米力农组显著减少(P<0.05)。治疗12周后,联合组6MWD、PASP、LVEF和PO2较本组治疗前均显著改善(P<0.01)。4组不良反应发生率的差异无统计学意义。结论贝前列素钠联合米力农治疗PH-LHD较常规组或单试药组疗效更好。

AIM To observe the clinical efficacy of beprostol combined with milrinone in the treatment of left heart disease-associated pulmonary hypertension(PH-LHD). METHODS From January 2019 to January 2021, 184 PH-LHD patients were randomly divided into 4 groups with 46 patients in each group.The routine treatment group was given symptomatic treatment such as oxygen inhalation, anticoagulation,diuresis and cardiotonic therapy;the beprostol sodium group was treated with oral beprostol sodium on the basis of routine treatment;the milrinone group was treated with milrinone intravenously on the basis of routine treatment;and the combination group was treated with peprostatin sodium and milrinone at the same time on the basis of routine treatment. The changes of brain natriuretic peptide(BNP), arterial partial pressure of oxygen(PO2), pulmonary artery systolic pressure(PASP), left ventricular ejection fraction(LVEF), 6-minute walking distance(6 MWD), WHO pulmonary hypertension function grade(WHO-FC) and side effects were observed before and after treatment in the four groups. RESULTS After 72 hours ’ treatment, BNP of the four groups was significantly lower than that before treatment(P<0.05), BNP of milrinone group and combination group was significantly lower than that of the other two groups(P<0.05, P<0.01), HR was significantly higher than that of the other two groups(P<0.01),and the hospitalization days of combination group were significantly less than those of the other three groups(P<0.05). After 12 weeks’ treatment, BNP, 6 MWD, PO2, PASP, LVEF and WHO-FC in combined group were significantly improved(P<0.01) as compared with those in routine group(P<0.05), the level of LVEF in combined group was significantly higher than that in beprostol sodium group(P<0.05) and the levels of 6 MWD, PO2 and PASP in combined group were significantly better than those in milrinone group(P<0.05). There was no significant difference in the incidence of adverse reactions among the four groups. CONCLUSION Beprostol sodium combined with milrinone is more effective in the treatment of PH-LHD than routine treatment or single use of beprostol sodium or milrinone.