法舒地尔治疗老年慢性肺源性心脏病临床疗效及其机制的随机对照研究

摘要

目的：探讨法舒地尔治疗老年慢性肺源性心脏病（CPHD）的临床疗效及其机制。方法前瞻性选取2014年10月—2015年3月西安市第二医院呼吸内科收治的老年 CPHD 患者76例为研究对象，采用随机数字表法分为治疗组38例和对照组38例。治疗组在 CPHD 内科常规药物治疗的基础上给予法舒地尔注射液静脉滴注；对照组在CPHD 内科常规药物治疗的基础上给予0.9%氯化钠注射液静脉滴注作为对照，共治疗14 d。治疗前及治疗后测定血压、心率、血气分析〔动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）〕、肺动脉收缩压（sPAP）；治疗前及治疗第7、14天检测超敏 C 反应蛋白（hs-CRP）、N 末端脑钠肽前体（NT-proBNP）水平。观察治疗期间不良事件。结果对照组因心力衰竭死亡1例，脱落率1.3%。治疗前及治疗后，治疗组与对照组患者收缩压、舒张压、心率比较，差异均无统计学意义（P >0.05）。治疗前，治疗组与对照组患者 PaO2、PaCO2、sPAP 比较，差异均无统计学意义（ P >0.05）。治疗后，治疗组较对照组患者 PaO2升高，PaCO2、sPAP 降低（P <0.05）。hs-CRP、NT-proBNP水平治疗方法与治疗时间存在交互作用（P <0.05），治疗方法主效应显著（P <0.05），治疗时间主效应显著（P <0.05）。治疗前，治疗组与对照组患者hs-CRP、NT-proBNP水平比较，差异均无统计学意义（ P >0.05）；治疗第7、14天，治疗组患者hs-CRP、NT-proBNP水平较对照组降低（P <0.05）。治疗期间，少数患者出现头昏（治疗组3例，对照组2例）、头痛（治疗组1例，对照组1例）等不适，停药后症状均消失，无其他明显药物不良反应。结论法舒地尔治疗老年 CPHD患者可提高 PaO2，降低 PaCO2、sPAP、hs-CRP及NT-proBNP水平，不增加不良反应。%Objective To evaluate the efficacy and mechanism of action of fasudil in the treatment of elderly patients with chronic pulmonary heart disease( CPHD). Methods The subjects enrolled in this study were 76 elderly patients with CPHD admitted to Department of Respiratory Medicine,Second Hospital of Xi′ an from October 2014 to March 2015 by a prospective method. And they were divided into the treatment group(n = 38)and the control group(n = 38)by random number table method. Based on the conventional medical therapy,the treatment group additionally received intravenous drip of fasudil injection,and the control group received intravenous drip of 0. 9% sodium chloride injection. And the treatment for both groups lasted for 14 days. Blood pressure,heart rate(HR),blood gas analysis〔partial pressure of oxygen(PaO2 ),partial pressure of carbon dioxide(PaCO2 )〕,systolic pulmonary arterial pressure(sPAP)were measured before and after treatment. Levels of hypersensitive C - reactive protein( hs-CRP)and N - terminal pro - brain natriuretic peptide( NT-proBNP)were measured before,at the 7th and 14th days after treatment,respectively. And adverse events occurred during treatment were observed. Results Of the patients in the control group,1 died of heart failure,and 1. 3% dropped out of the study. No significantly statistical differences were found in terms of systolic and diastolic blood pressure and HR between the two groups before and after treatment(P > 0. 05). Before treatment,no significant differences were observed in PaO2 ,PaCO2 and sPAP between the two groups(P > 0. 05),but after treatment,PaO2 was elevated and PaCO2 and sPAP were decreased in the treatment group(P <0. 05). Treatment method and time exerted interaction effect on levels of hs-CRP and NT-proBNP( P < 0. 05). Treatment method led to remarkable main effect on levels of hs-CRP and NT-proBNP(P < 0. 05). Treatment time also had significant main effect on levels of hs-CRP and NT-proBNP( P < 0. 05). Before treatment,levels of hs-CRP and NT-proBNP in the treatment group did not differ from those in the control group significantly(P > 0. 05),but at the 7th and 14th days after treatment,levels of hs-CRP and NT-proBNP in the treatment group were lowered(P < 0. 05). During the treatment,only a few patients had some side effects such as dizziness(3 in treatment group and 2 in control group)and headache(1 in treatment group and 1 in control group),but the symptoms disappeared when the medicine was stopped. Conclusion The treatment of fasudil in regular doses can effectively improve the PaO2 ,reduce PaCO2 ,sPAP,levels of hs-CRP and NT-proBNP in elderly patients with CPHD,do not increase adverse reactions.