黄体酮治疗肺心病呼吸衰竭疗效的初步观察

A Preliminary Observation of the Effect of Progesterone for the Respiratory Failure due to pulmonary Heart Disease.

目的为了观察黄体酮作为通气刺激剂在高碳酸血症和低氧血症的疗效。方法将106例肺心病呼吸衰竭患者和随机选择的14例肺心病无呼吸衰竭患者作为对照(第四组),106例呼吸衰竭患者分为三组,其中39例给予黄体酮10mg,肌注,每日两次,10天为一疗程(第一组),其中11例给予黄体酮和“肺脑合剂”(PCM):含5～10％葡萄糖500ml,可拉明1.875g,地塞米松10mg,静滴,每天一剂;34例患者给予肺脑合剂,10天为一疗程,(第二组);33例未给黄体酮,又未给肺脑合剂,只给抗菌药和对症药(第三组);对照组(第四组)也给黄体酮,所有病人在治疗始末均做血气分析检查。结果黄体酮治疗组(第一组):PaCO_2从平均(63.43±8.41)mmHg下降到(52.28±7.49)mmHg,平均下降11.15mmHg,有非常显著意义(P<0.001),PaO_2从(53.98±14.43)mmHg上升到(62.93±14.34)mmHg,平均增加8.95mmHg;肺脑合剂组(第二组):PaCO_2从平均(72.51±14.69)mmHg下降到(60.10±10.30)mmHg(P<0.001),但PaO_2仅从(53.18±19.14)mmHg上升到(58.88±19.10)mmHg(P>0.10),第三组PaCO_2从(56.12±10.51)mmHg下降到(52.68±9.78)mmHg(P>0.20),PaO_2从(52.39±9.04)mmHg上升到(60.19±12.87)mmHg(P<0.001);然而在第四组黄体酮的药理作用未能见到(P>0.50和P>0.20);在11例同一个体分别给予黄体酮和肺脑合剂的疗效观察中,同样得出类似于不同个体分别给予上述两剂的结果。结论上述结果显示黄体酮是一种安全、可靠的通气刺激药,较其他的呼吸兴奋药有更多的优越性,在严重高碳酸血症和低氧血症患者中,黄体酮依然可发挥其药理作用,但是在没有呼吸衰竭的病人,其药理作用是不明显的。

Objective In order to observe the effect of progesterone as a ventolatory stimulant drug for hypercapnia and hypoxemia. Methods 106 patients with respiratory failure due to COPD and 14 patients suffering from COPD without respiratory failure for control (group Ⅳ) were selected 106 patients with respiratory failure were divided into three groups: 39 patients were given progesterone 10mg, b.i.d intramuscularly for 10 days (group Ⅰ ), among them 11 patients were given progesterone and pulmo - cerebrostic mixture (PCM) with 5 - 10% glucose solution 500ml, coramine 1.875g, dexamethasone 10mg, qd intravenously in the course of hospitalization; 34 patients were only given PCM for 10 days (group Ⅱ) and 33 patients were given sensitive antibiotics and other symptomomlytic drugs but neither progesterone nor PCM (group Ⅲ) -Group Ⅳ patients were given progesterone.The patients were examined at the beginning and the end of the treatment. Arterial blood gases were analyzed in each case. Results The results showed that PaCO2 fell in all patients from a mean control of (63.43 ± 8.41) mmHg to (52.28±7.49) mmHg (P< 0.001), and PaCO2 rose in patients from a mean control of (53.0±14.43) mmHg to (62.93 ± 14.34) mmHg (P<0.05) in Group Ⅰ; in Group Ⅱ PaCO2 fell from a mean of'(72.51 ±14.69) mmHg to (60.10± 10.30) mmHg (P<0.001), but PaO2 only rose from (53.18±19.14) mmHg to (58.88±19.10) mmHg (P>0.10); in Group Ⅲ PaCO2 fell from (56.12± 10.51) mmHg to (52.68±9.78) mmHg (P>0.20), PaO2 rose from (52.39 ± 9.04) mmHg to (60.19 ± 12.87) mmHg (P<0.001) .However, in Group Ⅳ its pharmacologic effect was not found (P>0.50 and P> 0.20, respectively) and for 11 patients who were given progensterone and PCM respectively, changes similar to Group Ⅰ and Ⅲ were found. Conclusions These findings suggest that progesterone is a safe, reliable ventilatory stimulant drug with is effect on respiratory failure superior to other respiratory stimuli and that it is effective in patients with respiratory failure, even with severe hypercapnia and/or hypoxemia, but in patient without respiratory failure, its pharmacological effect is not fangible.