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目的 :比较吸入沙美特罗氟替卡松联合噻托溴铵与口服低剂量强的松联合氨茶碱对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺心病患者心功能的影响。方法:选取稳定期COPD合并肺心病患者111例随机分为3组,每组37例,常规治疗(利尿剂、血管扩张剂、强心剂)相同。对照组:未使用任何支气管扩张剂及激素类药物;吸入剂组:沙美特罗氟替卡松粉雾剂(50/500μg)1吸,2次/d、噻托溴铵1吸,1次/d,吸入;口服药组:强的松5 mg,1次/d,缓释型氨茶碱100 mg,2次/d,口服。分别于治疗前、治疗48周后测定患者的右心室流出道内径、右心室内径、右肺动脉干内径、平均肺动脉压、射血分数(LVEF)、钠尿肽(BNP)并比较分析,同时分析患者的空腹血糖、血浆皮质醇、骨密度。结果:与治疗前相比,治疗后吸入剂组、口服药组患者的心功能指标均有改善(P<0.05),且较对照组均有改善(P<0.05);吸入剂组在改善患者的右心室流出道内径、右心室内径、右肺动脉干内径、射血分数、钠尿肽方面稍优于口服药组(P<0.05),在改善平均肺动脉压方面差异无统计学意义(P>0.05)。治疗前后,3组患者空腹血糖、血浆皮质醇及骨密度对比均无显著性差异(P>0.05),且3组患者治疗前后血浆皮质醇水平均在正常值范围内。结论:在稳定期COPD合并肺心病的治疗中,吸入沙美特罗氟替卡松联合噻托溴铵与口服低剂量强的松联合氨茶碱均可改善患者心功能,其中吸入剂效果更佳。
Objective: To compare the effects of salmeterol and fluticasone combined with tiotropium and oral low dose prednisone and aminophylline on cardiac function in patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary heart disease. Methods: A total of 111 patients with stable COPD complicated with pulmonary heart disease were randomly divided into 3 groups (n = 37 in each group). The routine treatment (diuretic, vasodilator and cardiotonics) was the same. Control group: did not use any bronchodilators and hormonal drugs; Inhaler group: Salmeterol fluticasone powder aerosol (50 / 500μg) 1 suction, 2 times / d, tiotropium 1 absorption, 1 time / Inhalation; oral drug group: prednisone 5 mg, 1 / d, sustained-release aminophylline 100 mg, 2 times / d, orally. The right ventricular outflow tract diameter, right ventricular diameter, right pulmonary artery trunk diameter, mean pulmonary artery pressure, ejection fraction (LVEF), and natriuretic peptide (BNP) were measured and compared before treatment and 48 weeks after treatment, Fasting blood glucose, plasma cortisol, and bone mineral density in patients. Results: Compared with those before treatment, the indexes of cardiac function in inhalation group and oral administration group were improved (P <0.05), and were improved compared with those in control group (P <0.05). In inhaler group, Right ventricular outflow tract diameter, right ventricular diameter, right pulmonary artery diameter, ejection fraction, and natriuretic peptide were slightly better than those of oral administration group (P <0.05), and there was no significant difference in improving mean pulmonary arterial pressure (P> 0.05). There was no significant difference in fasting blood glucose, plasma cortisol and bone mineral density between the three groups before and after treatment (P> 0.05). Plasma cortisol levels of the three groups before and after treatment were within the normal range. Conclusion: In the treatment of stable COPD with pulmonary heart disease, inhaled salmeterol fluticasone combined with tiotropium and oral low-dose prednisone combined with aminophylline can improve cardiac function in patients with inhalation effect better.