【摘要】 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。更多还原

【Abstract】 Objective: To explore the influence of salmeterol fluticasone plus tiotropium bromide and low dosage prednisone plus aminophylline on cardiac function in patients with chronic obstructive pulmonary disease(COPD) combined with chronic cor pulmonale.Methods: A total of 111 cases of COPD with chronic cor pulmonale patients in the stationary stage were recruited as subjects and randomly divided into three groups with 37 cases in each. Three groups received same routine treatment(diuretic drug, vasolidator,cardiac stimulant). The control group solely received routine treatment. The inhalation group had additional therapies of sameterol fluticasone(50 / 500 μg) twice daily plus tiotropium bromide once per day. The oral drug group had additional therapies of prednisone 5 mg once per day plus slow release aminophylline 100 mg twice per day based on the routine treatment. The right ventricular outflow tract, right ventricular internal diameter, right pulmonary artery trunk, pulmonary artery pressure, left ventricular ejection fraction(LVEF) and brain natriuretic peptide(BNP) in the three groups were measured and compared before and after 48 weeks of treatment, as well as the fasting blood glucose, plasma cortisol and lumbar spine bone mineral density in these three groups.Results: After treatment, all of the cardiac function indexes in patients of the inhalation group and the oral drug group were improved compared to those before treatment(P < 0.05) and those of the control group(P < 0.05). There were no significant differences existed in the pulmonary artery pressure of the inhalation group and oral drug group after treatment(P > 0.05). However,the right ventricular outflow tract, right ventricular internal diameter, right pulmonary artery trunk, LVEF and BNP in the inhalation group were more significantly improved than those in the oral drug group(P < 0.05). There were no significant differences among the fasting blood glucose, plasma cortisol and lumbar spine bone mineral density of these three groups before and after treatment(P >0.05), and the levels of plasma cortisol in the three groups were all in normal level before and after treatment. Conclusion: Both of salmeterol fluticasone plus tiotropium bromide and low dosage prednisone plus aminophylline improve cardiac function in patients with chronic obstructive pulmonary disease combined with chronic cor pulmonale, and the former seems better.更多还原