益肺Ⅱ号治疗慢性阻塞性肺疾病肺动脉高压（痰瘀阻肺型肺胀）临床观察

【作者】 杨宏志；

【导师】 刘青；

【作者基本信息】 湖北中医学院 ， 中医内科学， 2004， 硕士

【摘要】 目的 慢性阻塞性肺疾病（COPD）是临床上的常见病、多发病。肺动脉高压（PAH）是COPD发展至肺心病的关键病理环节，是影响COPD患者病程、预后和生活质量的一个极其重要因素。本试验旨在观察益肺Ⅱ号治疗COPD继发性PAH的临床疗效，探讨益肺Ⅱ号的作用机制，为临床用药提供科学依据。 方法 选取中医辨证为痰瘀阻肺型肺胀的COPD继发性PAH患者52例，随机分为两组，治疗组和对照组各26例。对照组予以吸氧、抗感染、解痉平喘和化痰等常规治疗。治疗组在常规治疗的基础上予以益肺Ⅱ号煎剂口服，每次100ml，每日3次。两组疗程均为14天。观察两组患者治疗前后症状、体征、血流动力学、右心功能、血气分析及肺功能的变化，并进行临床疗效评价。 结果 1 两组总疗效比较：治疗组显效率和总有效率分别为57.69％和92.31％，与对照组比较，有显著差异（P＜0.01），治疗组疗效明显优于对照组。 2 主要症状体征疗效比较：治疗组在改善患者喘息、气短或呼吸困难和咯痰上疗效明显高于对照组，控显率和有效率与对照组相比，差异有显著统计学意义（P＜0.01）。治疗组在改善患者咳嗽和啰音上疗效也明显高于对照组，控显率和有效率与对照组相比，差异有统计学意义（P＜0.05或P＜0.01）。 3 血流动力学指标比较：用药后，治疗组患者平均肺动脉压（mPAP）和肺血管阻力（PVR）明显降低，与对照组比较，差异有显著统计学意义（P＜0.01或P＜0.001），而患者体循环压力（mSAP）、心率（HR）和心输出量（CO）无明显变化，与治疗前相近（P＞0.05），说明对肺循环的选择性好。 4 右心功能指标比较：治疗组Q-B间期和Q-B／B-Y显著降低，B-YI和α上升时间显著升高，与对照组比较，P＜0.001；B-Y间期和HS幅度明显升高，Q-BI明显降低，与对照组比较，P＜0.01，说明患者右心功能得到明显改善。 5 血气分析指标比较：治疗组在提高患者动脉血氧分压（PaO₂）上疗效明显高于对照组（P＜0.05），在降低患者动脉血二氧化碳分压（PaCO₂）上疗效与对照组相近（P＞0.05）。 6 肺功能指标比较：对照组肺功能各项指标治疗后改善不明显，与治疗前比较，差异无统计学意义（P＞0.05）。治疗组FVC、FEV₁占预计值百分比和FEV₁／FVC％明显升高，与治疗前和对照组治疗后比较，有明显差异（P＜0.01或P＜0.05）。治疗组VC和VC％较治疗前也有所升高（P＜0.05），但与对照组治疗后比较，无明显差异（P＞0.05）。 结论 益肺Ⅱ号能够明显改善COPD继发性PAH患者的临床症状和体征，降低mPAP和PVR，改善右心功能和肺功能，提高PaO₂，并且对患者mSAP、HR和CO无明显影响，疗效确切，是治疗COPD继发性PAH的有效方药。更多还原

【Abstract】 ObjectiveTo observe the therapeutic effect and mechanism of action of Yi Fei No. II on pulmonary artery hypertension (PAH) in patients with chronic obstructive pulmonary disease (COPD) .To provide scientific basis for clinical treatment. MethodsFifty-two COPD patients complicated by PAH were randomly divided into two groups including twenty-six patients in therapy group and the other twenty-six patients in control group. Patients in therapy group were treated with Yi Fei No. II (100ml, p.o., three times ervery day)on the base of conventional therapy and patients in control group were treated only with conventional therapy. Course of treatment in both groups were 14 days. It was designed to investigate the changes of clinical symptoms, physical signs, hemodynamics, the function of right heart, arterial blood gas analysis and pulmonary function. Results1 The total effective rates of therapy group and control group were 92.31% and 26.92 % respectively.The difference between two groups was statistical significant (P<0.01) .The therapeutic effect of therapy group surpassed that of control group.2 The improvement of clinical symptoms and physical signs in therapy group, especially of pant, dyspnea and stethocatharsis, was better than that in control group. The difference between two groups were statistical significant (P<0.05or P<0.01).3 In therapy group, the levels of mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistant (PVR) were obviously reduced (P<0.01orP<0.001), while the levels of mean systemic circulation arterial pressure (mSAP), heart rate(HR) and cardiac output (CO) was invariably (P>0.05 ).4 In therapy group, the levels of Q-B interval, Q-B/B-Yand Q-BI were obviously reduced (P<0.0lorP<0.00l).The levels of B-Y interval, B-YI, time and HS were obviously increased (P < 0.01 orP<0.001). In other words, the function of right heart was obviously improved in therapy group.5 In therapy group, the levels of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1% and PaO2 were obviously increased, and the degree of increase in therapy group was higher than that in control group(y<0.05). ConclusionFor COPD patients complicated by PAH, Yi Fei No. II can improve the clinical symptoms, physical signs , the function of lung and right heart, reduce the levels of mPAP, PVR and increase the levels of PaO2. But it can’t influence the levels of mSAP, HR and CO. In other words, Yi Fei No. II is an effective drug.更多还原