米力农对慢性阻塞性肺疾病引起慢性肺源性心脏病合并右心衰临床疗效观察

摘要

目的 探讨米力农治疗慢性阻塞性肺疾病(COPD)引起慢性肺源性心脏病合并右心衰的临床疗效.方法 选择COPD引起慢性肺源性心脏病合并右心衰竭病人45例,治疗组25例,对照组20例.两组均给予常规综合治疗,治疗组加用米力农微泵静脉持续泵入治疗,观察病人心率、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、B型脑钠肽(BNP)变化;及心脏彩超左室射血分数(LVEF)、肺动脉压(PAP)、右室内径、三尖瓣反流变化.结果 两组病人治疗后心率、BNP较治疗前均明显下降(P<0.001),治疗组BNP下降更明显,低于对照组水平(P<0.05).两组病人治疗后LVEF均有改善,PAP、右室内径较治疗前有下降(P<0.001),治疗组与对照组间比较,差异无统计学意义(P>0.05).中度肺动脉高压病人治疗后BNP明显下降,LVEF升高,右室内径减小(P<0.05),重度肺动脉高压病人治疗后BNP明显下降,右室内径减小(P<0.05),LVEF有改善,但差异无统计学意义(P>0.05).结论 短期使用米力农治疗COPD引起慢性肺源性心脏病合并右心衰能够有效缓解右心衰的临床症状,降低心率、BNP、PAP及右室内经.%Objective To investigate the clinical effect of milrinone for chronic pulmonary heart disease complicating heart failure causedbychronicobstructivepulmonarydisease.Methods Totally 45 patients with chronic pulmonary heart disease complicating heart failure caused by chronic obstructive pulmonary disease were enrolled,25 patients in treatment group and 20 patients in control group.Two groups of patients were treated with routine comprehensive therapy,and additionally the treatment group was treated with milrinone continuously pumped into veins in the form of micropump,and the patients'heart rate,arterial blood PaO2 ,PaCO2 ,B-type na-triuretic peptide(BNP)changes were observed;the left ventricular ejection fraction (LVEF),pulmonary artery pressure (PAP),right ventricular inside diameter,and tricuspid valve regurgitation changes were also observed.Results Thepatient'sheartrateandBNPof the two groups decreased significantly than before after the treatment (P<0.001 ),while BNP of the treatment group decreased more significantly,lower than the control group (P<0.05 ).After the treatment the LVEF of the two groups were improved,PAP and right ventricular diameter lower than before(P<0.001),however the difference between the two groups was not statistically significant (P>0.05).BNP and the right ventricular diameter(P>0.05)of the patients with moderate pulmonary artery hypertension decreased after the treatment,while the LVEF of the patients increased.BNP and the right ventricular diameter(P<0.05 )of the patients with severe pulmonary artery hypertension decreased after the treatment,while the LVEF of the patients improved but the difference was not statisti-callysignificant(P>0.05).Conclusions The short-term application of milrinone to the treatment of chronic pulmonary heart disease complicated with right heart failure caused by chronic obstructive pulmonary disease can effectively relieve the clinical symptoms of the right heart failure,reduce the heart rate,BNP,PAP and right ventricular inside diameter.