硝普钠在肺心病顽固性心力衰竭并高血压中的应用

Effects of sodium nitroprusside on obstinate heart failure of pulmonary heart disease complicated with hypertension

目的 观察硝普钠伍用多巴胺治疗慢性肺心病顽固性心力衰竭并高血压的疗效。方法 除继续采用有效抗生素、吸氧、保持呼吸道通畅等对症治疗外 ,予硝普钠 5 0 m g、多巴胺 2 0 mg加入 5 %葡萄糖注射液 5 0 0 ml中避光静脉滴注 ,疗程 3 d。结果 显效 2 9例 (72 .5 % ) ,有效 11例 (2 7.5 % ) ,总有效率达 10 0 % ;用药 3 0 m in后心率、呼吸频率、血压即有明显改善 (P<0 .0 5 ,P<0 .0 1) ,治疗后改善更为显著 (P<0 .0 1) ;心率血压乘积明显下降 (P<0 .0 1) ,心肌耗氧量降低 ;随着疗程的进行 ,左心室射血分数 (L VEF)、左心室短轴缩短率 (FS)及舒张早期最大充盈速度(E)与舒张晚期最大充盈速度 (A)的比值 (E/ A)明显增加 ,治疗后增加显著 (P<0 .0 1) ;血浆 NO增加 (P<0 .0 5 ) ,第一秒用力呼气量 (FEV1 )、动脉血氧分压 (Pa O2 )和动脉血二氧化碳分压 (Pa CO2 )均较治疗前有所改善 (P<0 .0 5 ,P<0 .0 1) ;治疗后共有 14例 (43 .8% )原有心律失常消失。

Objective To investigate the effects of sodium nitroprusside and dopamine on obstinate heart failure of pulmonary heart disease complicated with hypertension.Methods With the maintenance of anti inflammatory agents,oxygen inhalation and unobstructed pneogaster,40 cases were intravenously given sodium nitroprusside 50mg and dopamine 20mg in 500ml of 5% glucose injection.The treatment lasts 3 days.Results Marked effectiveness 29 cases(72.5%),effectiveness 11 cases(27.5%),total effective rate 100%.The heart rate(HR),respiratory rate(R) and blood pressure(BP) improved ( P <0.05, P <0.01)after 30 minutes of the treatment, and improved significantly after therapy( P <0.01).The multiplication of HR by SBP decreased significantly( P <0.01).It means myocardial oxygen consumption was reduced.The left ventricular ejection fraction(LVEF),fraction shortening(FS)and the rate of filling velocity in early diastole to that in late diastole(E/A) were increasing with the continuation of treatment, and increased significantly after therapy( P <0.01).Plasma NO increased( P <0.05).Forced expiratory volume(FEV 1),PaO 2 and PaCO 2 also improved significantly ( P <0.05, P <0.01).The arrhythmia of 14 cases(43.8%)disappeared after therapy. Conclusion sodium nitroprusside and dopamine have good effects on obstinate heart failure of pulmonary heart disease complicated with hypertension.