中医肺康复联合西药常规治疗慢性阻塞性肺疾病合并肺心病的临床效果及对患者肺功能、脑钠肽的影响

Clinical efficacy of traditional Chinese medicine lung rehabilitation combined with western medicine in the treatment of chronic obstructive pulmonary disease complicated with pulmonary heart disease and its effect on pulmonary function and brain natriuretic peptide

目的探讨中医肺康复联合西药常规治疗慢性阻塞性肺疾病(COPD)合并肺心病(PHD)的临床效果及对患者肺功能、脑钠肽的影响。方法选取2019年1月至2021年9月宜春市人民医院收治的120例COPD合并PHD患者作为研究对象,按照随机数字表法分为两组,每组60例。对照组接受西药常规治疗,观察组接受中医肺康复联合西药常规治疗。比较两组患者治疗前后肺功能指标、肺动脉收缩压(PASP)、多普勒左心射血等容时间(Tei)指数、运动耐力、血气分析指标、生化指标以及生活质量的变化情况。结果两组患者干预前肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气容积占预计值百分比(FEV_(1)%)、第1秒用力呼气容积(FEV_(1))/FVC比较,差异无统计学意义(P>0.05);两组患者干预后VC、FVC、FEV_(1)%、FEV_(1)/FVC检测结果均高于同组干预前,差异有统计学意义(P<0.05);观察组干预后VC、FVC、FEV_(1)%、FEV_(1)/FVC检测结果均高于对照组,差异有统计学意义(P<0.05);两组患者干预前PASP、Tei指数、6 min步行试验(6MWT)、圣乔治呼吸问卷(SGRQ)评分比较,差异无统计学意义(P>0.05);两组患者干预后PASP、Tei指数、SGRQ评分均低于同组干预前,6MWT均高于同组干预前,差异有统计学意义(P<0.05);观察组干预后PASP、Tei指数、SGRQ评分均低于对照组,6MWT高于对照组,差异有统计学意义(P<0.05)。两组患者干预前血氧分压(PaO_(2))、血二氧化碳分压(PaCO_(2))检测结果比较,差异无统计学意义(P>0.05);两组患者干预后PaO_(2)检测结果均高于同组干预前,PaCO_(2)检测结果均低于同组干预前,差异有统计学意义(P<0.05);观察组干预后PaO_(2)检测结果高于同组干预前,PaCO_(2)检测结果低于同组干预前,差异有统计学意义(P<0.05)。两组患者干预前脑钠肽(BNP)、肌钙蛋白(CTnI)、D-二聚体(D-D)、红细胞比积(HCT)检测结果比较,差异无统计学意义(P>0.05);两组患者干预后BNP、CTnI、D-D、HCT检测结果均低于同组干预前,差异有统计学意义(P<0.05);观察组干预后BNP、CTnI、D-D、HCT检测结果均低于对照组,差异有统计学意义(P<0.05)。结论中医肺康复联合西药常规治疗COPD合并PHD疗效显著,能够有效改善患者心肺功能,值得临床推荐。

Objective To investigate the clinical effect of lung rehabilitation combined with western medicine in the treatment of chronic obstructive pulmonary disease(COPD)complicated with pulmonary heart disease(PHD)and its effect on pulmonary function and brain natriuretic peptide.Methods A total of 120 patients with COPD and PHD admitted to Yichun People's Hospital from January 2019 to September 2021 were selected as the subjects of this study.They were divided into two groups according to the random number table,with 60 cases in each group.The control group received routine western medicine treatment,and the observation group received traditional Chinese medicine lung rehabilitation combined with routine western medicine treatment.The changes of pulmonary function index,pulmonary artery systolic pressure(PASP),total ejection isovolume(Tei)index,exercise endurance,blood gas analysis index,biochemical index and quality of life were compared between the two groups before and after treatment.Results The results of vital capacity(VC),forced vital capacity(FVC),forced expiratory volume of 1s as a percentage of the estimate(FEV_(1)%)and forced expiratory volume of 1s(FEV_(1)/FVC)were not significantly different between the two groups before intervention(P>0.05).After intervention,the results of VC,FVC,FFEV_(1)%and FEV_(1)/FVC in the two groups were higher than those before intervention,and the differences were statistically significant(P<0.05).After intervention,the results of VC,FVC,FEV_(1)%and FEV_(1)/FVC in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in PASP,Tei index,6 min walking test(6MWT)and St.George's respiratory questionnaire(SGRQ)score between the two groups before intervention(P>0.05).After intervention,PASP,Tei index and SGRQ score of the two groups were lower than those before intervention,and 6MWT was higher than that before intervention,and the differences were statistically significant(P<0.05).After intervention,PASP,Tei index and SGRQ score of the observation group were lower than those of the control group,and 6MWT was higher than that of the control group,and the differences were statistically significant(P<0.05).There were no significant differences in partial pressure of oxygen(PaO_(2))and arterial partial pressure of oxygen(PaCO_(2))between the two groups before intervention(P>0.05).After intervention,the PaO_(2) of the two groups was higher than that before intervention,and the PaCO_(2) was lower than that of the same group before intervention,and the differences were statistically significant(P<0.05).After intervention,the PaO_(2) of the observation group was higher than that of the group,the PaCO_(2) was lower than that of the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the results of brain natriuretic peptide(BNP),cardiac troponin(CTnI),D-dimer(D-D)and hematocrit(HCT)between the two groups before intervention(P>0.05).The results of BNP,cTnI,D-D and HCT in the two groups after intervention were lower than those in the same group before intervention,and the differences were statistically significant(P<0.05).After intervention,the results of BNP,cTnI,D-D and HCT in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Traditional Chinese medicine lung rehabilitation combined with Western medicine in the treatment of COPD complicated with PHD has a significant effect,which can effectively improve the cardiopulmonary function of patients,and is worthy of clinical recommendation.