【摘要】 目的:观察中西医结合疗法治疗慢性肺源性心脏病(CPHD)急性期(痰瘀壅肺型)的临床疗效及对血液流变学、血浆内皮素-1(ET-1)、血栓素B2(TXB2)和6-酮前列腺素F_la(6-Keto-PGF_la)水平的影响。方法:将90例住院患者分为对照组和观察组各45例。对照组采用西医常规疗法,包括控制性氧疗、抗感染、祛痰、平喘、抗心衰等综合措施。观察组在对照组治疗的基础上采用小陷胸汤、三子养亲汤合血腑逐瘀汤加减治疗。两组疗程均为4周。测量治疗前后动脉二氧化碳分压(PaCO2)、氧分压(PaO2)和肺动脉压(mPAP);检测治疗前后血液流变学、ET-1,TXB2,6-Keto-PGF_la;每周记录治疗后主要症状及体征积分。结果:观察组临床疗效总有效率91.11%,优于对照组的75.56%(P<0.05);治疗后观察组mPAP和PaCO2水平低于对照组,PaO2高于对照组(P<0.01);治疗后观察组血液流变学指标全血黏度、血浆黏度、纤维蛋白原、血小板聚集率和红细胞沉降率的改善均优于对照组(P<0.01);治疗后观察组ET-1和TXB2低于对照组,6-Keto-PGF_la高于对照组(P<0.01);观察组在治疗后1,2,3,4周主要症状和体征积分均低于对照组(P<0.01)。结论:采用中西医结合疗法治疗CPHD急性期患者能减轻临床症状、体征,改善肺的通气功能,改善血液高凝、高黏滞状态,改善肺循环淤血,降低肺动压,从而提高临床疗效。更多还原

【Abstract】 Objective: The observe clinical effects of treating cor pulmonale at acute phase(phlegm and blood stasis type indicates the lungs) through traditional Chinese medicine combined with western medicine and influence of hemorheology,endothelin-1(ET-1),thromboxane B2(TXB2) and 6-Ketone prostaglandin F_la(6-Keto-PG F_la) ’s level. Method: Ninety patients were randomly divided into control group(45 cases) and observation group(45 cases). Patients in control group received conventional western medicine therapy,including controlling oxygen cure,anti-infection,expectorant,smooth wheezing,heart failure and other comprehensive measures. Based on the treatment of control group,patients in observation group added and subtract treatment of Xiaoxianxiong decoction,Sanzi Yangqin decoction and Xuefu Zhuyu decoction. Treatment courses continued for 4weeks. Measure arterial carbon dioxide partial pressure(PaCO2),oxygen partial pressure(PaO2),pulmonary artery pressure(mPAP) before and after treatment. Test hemorheology,ET-1,TXB2 and 6-Keto-PG F_ la’s level before and after treatment. Record treatment of main symptoms and signs scores every week. Result: The total effective rate of curative efficacy in observation group was 91. 11% superior to 75. 56% in control group(P <0. 05). The level of mPAP and PaCO2 in observation group was lower than that in control group,while the level of PaCO2 in observation group was higher than that in control group after treatment(P < 0. 01). Observation group’s improvement of blood rheology indexes whole blood viscosity,plasma viscosity,fibrinogen,platelet aggregation rate and erythrocyte sedimentation rate were better than those data in control group(P < 0. 01). The level of ET-1 and TXB2 in observation group were lower than the data in control group. At the same time,observation group’s6-Keto-PG F_ la level was higher than that in control group after treatment(P < 0. 01). At the first,second,third and fourth mouth after the treatment,main symptoms and signs scores in observation group were lower than those in control group(P < 0. 01). Conclusion: Traditional Chinese medicine combined with western medicine can relieve symptoms and signs, ameliorate ventilatory function of lung, hypercoagulability of blood, high viscosity of blood and congestion of pulmonary circulation, reduce pulmonary artery pressure in treating cor pulmonale at acute phase,and it can improve clinical efficacy.更多还原