法舒地尔联合无创正压通气治疗慢性肺源性心脏病急性加重的临床价值

Fasudil combined with noninvasive positive pressure ventilation for treatment of acute exacerbation of chronic pulmonary heart disease

摘要:

目的  探讨法舒地尔联合无创正压通气治疗慢性肺源性心脏病急性加重患者的治疗价值。方法  住院治疗的慢性肺源性心脏病急性加重患者98例，随机分为对照组48例，予以抗感染、吸氧、扩张气道及祛痰等常规治疗及无创正压通气治疗，观察组50例，在对照组治疗基础上联合法舒地尔治疗。观察两组患者的临床治疗效果，比较两组患者治疗前、后的动脉血气指标：酸碱度（pH）、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、动脉血二氧化碳分压（PaCO2）；呼吸频率（RR）、心率（HR）、收缩压（SBP）、舒张压（DBP）、肺动脉压力（PASP）、内皮素-1（ET-1）、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）及N-端脑钠素前体（NT-proBNP）水平的变化。结果  两组患者治疗后的动脉血pH、PaO2、SaO2均较治疗前增加（P <0.05），但观察组增加优于对照组（P <0.05）；两组治疗后PaCO2、RR、HR、PASP、ET-1、hs-CRP及NT-proBNP较治疗前均下降（P <0.05），治疗后PASP下降观察组与对照组比较差异有统计学意义（P <0.05）；观察组临床治疗效果优于对照组（P <0.05）。结论  法舒地尔联合无创正压通气治疗可以明显改善慢性肺心病急性加重患者的动脉血气水平，降低肺动脉压力及炎症因子水平，具有肯定的治疗价值。

Abstract:

Objective To investigate the therapeutic value of Fasudil combined with noninvasive positive pressure ventilation in the treatment of acute exacerbation of chronic pulmonary heart disease. Methods A total of 98 hospitalized cases with acute exacerbation of chronic pulmonary heart disease were randomly divided into two groups. The control group (n = 48) received the conventional treatment of anti-infection, oxygen inhalation, airway dilation and expectorant together with noninvasive positive pressure ventilation. The observation group (n = 50) used Fasudil combined with the above treatment. The therapeutic effects were observed in the two groups. And the clinical parameters were compared before and after treatment between the two groups which included the arterial blood gas indexes (PaO2, SaO2, PaCO2, pH), respiratory rate (RR), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulmonary arterial pressure (PASP), endothelin-1 (ET-1), hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α) and N-terminal brain natriuretic peptide (NT-proBNP). Results The levels of pH, PaO2 and SaO2 significantly increased after treatment in the two groups (P < 0.05), and were significantly higher in the observation group (P < 0.05). After thetreatment, the levels of PaCO2, RR, HR, PASP, ET-1, hs-CRP and NT-proBNP significantly decreased in both groups (P < 0.05); the level of PASP decrease was significantly different between the two groups (P < 0.05). The clinical therapeutic effect of the observation group was better than that of the control group (P < 0.05). Conclusions Fasudil combined with noninvasive positive pressure ventilation therapy has certain therapeutic value in patients with acute exacerbation of chronic pulmonary heart disease, because the combined treatment can significantly improve the level of arterial blood gas indexes and reduce pulmonary artery pressure and inflammatory factor level.