丹参注射液辅助波生坦治疗特发性肺动脉高压的临床疗效及其对患者肺血流动力学和肺功能的影响

摘要

目的：观察丹参注射液辅助波生坦治疗特发性肺动脉高压（IPAH）的临床疗效，并探讨其对患者肺血流动力学和肺功能的影响。方法选取上海交通大学医学院附属同仁医院急诊内科2013年1月—2015年3月收治的IPAH 患者144例，随机分为对照组和试验组，每组72例。两组患者入院后均给予常规治疗，对照组患者在常规治疗基础上给予波生坦片，试验组患者在对照组基础上给予丹参注射液；两组患者均连续治疗4周。比较两组患者临床疗效，治疗前后肺血流动力学指标〔肺动脉舒张压（PADP）、肺动脉收缩压（PASP）、平均肺动脉压（MPAP）及肺血管阻力（PVR）〕、肺功能指标〔用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、FEV1/ FVC〕及治疗期间不良反应发生情况。结果试验组患者临床疗效优于对照组（P ﹤0.05）。治疗前两组患者 PADP、PASP、MPAP、PVR 比较，差异无统计学意义（P ﹥0.05）；治疗后试验组患者 PADP、PASP、MPAP、PVR 低于对照组（P ﹤0.05），且两组患者治疗后 PADP、PASP、MPAP、PVR 低于治疗前（P ﹤0.05）。治疗前两组患者 FVC、FEV1、FEV1/ FVC 比较，差异无统计学意义（P ﹥0.05）；治疗后试验组患者 FVC、FEV1、FEV1/ FVC 高于对照组（P ﹤0.05），且两组患者治疗后 FVC、FEV1、FEV1/ FVC 高于治疗前（P ﹤0.05）。试验组患者不良反应发生率低于对照组（P ﹤0.05）。结论丹参注射液辅助波生坦治疗 IPAH 的临床疗效确切，可有效改善患者肺血流动力学及肺功能，且安全性较高。%Objective To observe the clinical effect of danshen injection in the adjuvant therapy for idiopathic pulmonary hypertension treated by bosentan,to investigate the impact on pulmonary hemodynamics and pulmonary function. Methods From January 2013 to March 2015,a total of 144 patients with idiopathic pulmonary hypertension were selected in the Department of Emergency Medicine,Tongren Hospital Affiliated to Medicine School,Shanghai Jiaotong University,and they were randomly divided into control group and experiment group,each of 72 cases. Patients of the two groups received conventional treatment after admission,meanwhile patients of control group were given extra bosentan tablets,while patients of experiment group were given extra danshen injection based on that of control group;both groups continuously treated for 4 weeks. Clinical effect,pulmonary hemodynamic index〔 including pulmonary arterial diastolic pressure( PADP),pulmonary arterial systolic pressure(PASP),mean pulmonary arterial pressure( MPAP) and pulmonary vascular resistance( PVR)〕and index of pulmonary function〔including forced vital capacity(FVC),forced expiratory volume in one second(FEV1 )and FEV1 / FVC〕before and after treatment,and incidence of adverse reactions were compared between the two groups. Results The clinical effect of experiment group was statistically significantly better than that of control group(P ﹤ 0. 05). No statistically significant differences of PADP,PASP,MPAP or PVR was found between the two groups before treatment(P ﹥ 0. 05);after treatment, PADP,PASP,MPAP and PVR of experiment group were statistically significantly lower than those of control group,meanwhile PADP,PASP,MPAP and PVR of the two groups were statistically significantly lower than those before treatment(P ﹤ 0. 05). No statistically significant differences of FVC,FEV1 or FEV1 / FVC was found between the two groups before treatment( P ﹥0. 05);after treatment,FVC,FEV1 and FEV1 / FVC of experiment group were statistically significantly higher than those of control group,meanwhile FVC,FEV1 and FEV1 / FVC of the two groups were statistically significantly higher than those before treatment(P ﹤ 0. 05). The incidence of adverse reactions of experiment group was statistically significantly lower than that of control group( P ﹤ 0. 05). Conclusion Danshen injection has certain clinical effect in the adjuvant therapy for idiopathic pulmonary hypertension treated by bosentan,can effectively improve the pulmonary hemodynamic index and index of pulmonary function,with relatively high safety.