波生坦治疗成人慢性阻塞性肺疾病所致肺动脉高压的效果观察

Effect of Boscntan on Pulmonary Hypertension Caused by Chronic Obstructive Pulmonary Disease in Adults

目的探讨成人慢性阻塞性肺疾病所致肺动脉高压患者.在常规治疗基础上加用波生坦的临床效果。方法选择2019年1月-2020年12月锦州医科大学附属第二医院收治的成人慢性阻塞性肺疾病导致的肺动脉高压患者80例,随机分为观察组和对照组各40例。对照组采用常规治疗.观察组在常规治疗基础上加用波生坦。两组治疗12周后比较肺动脉压、右心功能和血清学指标情况。结果治疗后两组肺动脉压指标均较治疗前得到改善,且治疗后观察组肺动脉收缩压和肺动脉舒张压低于对照组,肺循环血流量和体循环血流量比值高于对照组,差异均有统计学意义(P<0.05)。治疗后两组右心功能指标均较治疗前得到改善,且治疗后观察组右心室侧壁三尖瓣环收缩期位移和右心室侧壁三尖瓣环收缩期峰值运动速度均高于对照组,右心室心肌工作指数低干对照组,差异均有统计学意义(P<0.05)。治疗后两组内皮素-1,肾上腺髓质素和缺氧诱导因子-1α均较治疗前降低,且观察组低于对照组,差异均有统计学意义(P<0.05)。结论成人慢性阻塞性肺疾病所致肺动脉高压患者,在常规治疗基础上加用波生坦,可进一步改善患者的肺动脉压状态和右心功能,缓解机体缺氧状态,值得临床推广应用。

Objective To investigate the clinical effect of bosentan on adult patients with pulmonary hypertension(PH)caused by chronic obstructive pulmonary disease(COPD).Methods A total of 80 adult patients with PH caused by COPD treated in the Second Affiliated Hospital of Jinzhou Medical University from January 2019 to December 2020 were randomly divided into observation group and control group with 40 cases in each group.The control group was treated with routine treatment,and the observation group was treated with bosentan on the basis of routine treatment.Pulmonary artery pressure,right heart function and serological indexes were compared between the two groups after 12 weeks of treatment.Results After treatment,the indexes of pulmonary artery pressure in the two groups were improved compared with those before treatment.After treatment,the pulmonary artery systolic pressure and pulmonary artery diastolic pressure in the observation group were significantly lower than those in the control group,and the ratio of pulmonary circulation blood flow to systemic circulation blood flow was significantly higher than those in the control group(P<0.05).After treatment,the indexes of right ventricular function in the two groups were improved compared with those before treatment.After treatment,the systolic displacement and the systolic peak velocity of tricuspid annulus in right ventricular sidewall in the observation group were significantly higher than those in the control group,and myocardial performance index of the right ventricular was significantly lower than that in the control group(P<0.05).Endothelin-1,adrenomedullin and hypoxia inducible factor-1α after treatment were significantly lower than before treatment in both groups,and the observation group were significantly lower than the control group(P<0.05).Conclusion In adult patients with PH caused by COPD,bosentan combined with conventional treatment can further improve the pulmonary artery pressure state and right heart function,and alleviate the hypoxia state of the body,which is worthy of clinical application.