【摘要】 目的 观察左西孟旦联合前列地尔治疗左心疾病相关性肺动脉高压(pulmonary hypertension associated with left heart disease,PH-LHD)的临床疗效。方法 回顾性分析2012年1月至2018年10月在我院心脏中心住院的PH-LHD患者98例,其中试验组48例、对照组50例。对照组给予吸氧、利尿、扩张外周血管、改善心肌重构等治疗,试验组在此基础上给予左西孟旦联合前列地尔治疗,观察两组患者治疗前后心功能、心率(HR)、收缩压(SBP)、左心室射血分数(LVEF)、肺动脉收缩压(PASP)、氨基末端脑钠肽前体(NT-proBNP)的变化情况。结果 对照组治疗后的HR(89.76±7.35)次/min、PASP(43.10±6.91)mm Hg、NT-proBNP(3 131.97±577.61)ng/L均低于治疗前的HR(110.86±10.70)次/min、PASP(57.35±8.34)mm Hg、NT-proBNP(5988.53±834.08)ng/L;试验组治疗后的HR(76.83±10.97)次/min、PASP(34.61±7.36)mm Hg、NT-proBNP(2768.64±787.11)ng/L也均低于治疗前的HR(111.92±10.59)次/min、PASP(60.18±6.81)mm Hg、NT-proBNP(6321.63±927.58)ng/L。对照组治疗后的SBP(126.32±10.36)mm Hg和LVEF(45.38±4.28)%高于治疗前的SBP(111.94±8.56)mm Hg和LVEF(38.60±5.91)%;试验组治疗后的SBP(130.17±7.12)mm Hg和LVEF(47.08±3.48)%也高于治疗前的SBP(109.19±8.77)mm Hg和LVEF(39.42±4.68)%。两组患者的心功能亦较治疗前改善,但试验组变化幅度大于对照组,差异有统计学意义(P<0.05)。结论 左西孟旦联合前列地尔治疗可显著降低PH-LHD患者的PASP,提高LVEF,改善心功能,值得临床推广应用。更多还原

【Abstract】 Objective To explore the efficacy of Levosimendan combined with Alprostadil in the treatment of pulmonary hypertension associated with left heart disease(PH-LHD).Methods 98 patients with PHLHD in department of cardiology in First Affiliated Hospital of Tsinghua University from January 2012 to October2018 were divided into experimental group of 48 cases and control group of 50 cases.The control group was treated with conventional anti-heart failure treatment(Oxygen inhalation,diuresis,dilatation of peripheral blood vessels and improvement of myocardial remodeling).The experimental group was treated with Levosimendan combined with Alprostadil on the base of conventional treatment.The changes of heart rate(HR),systolic blood pressure(SBP),left ventricular ejection fraction(LVEF),pulmonary artery systolic pressure(PASP),N terminal B type natriuretic peptide(NT-proBNP)before and after treatment in two groups were observed. Results The HR(89.76±7.35)beat/min,PASP(43.10±6.91)mm Hg and NT-proBNP(3131.97±577.61)ng/L after treatment were lower than HR(110.86±10.70)beat/min,PASP(57.35±8.34)mm Hg,NT-proBNP(5988.53±834.08)ng/L before treatment in the control group.The HR(76.83±10.97)beat/min,PASP(34.61±7.36)mm Hg,NT-proBNP(2768.64±787.11)ng/L after treatment were lower than HR(111.92±10.59)beat/min,PASP(60.18±6.81)mm Hg,NT-proBNP(6321.63 ±927.58)ng/L before treatment in the experimental group too.SBP(126.32±10.36)mm Hg and LVEF(45.38±4.28)%after treatment were higher than SBP(111.94±8.56)mm Hg and LVEF(38.60±5.91)%before treatment in the control group.SBP(130.17±7.12)mm Hg and LVEF(47.08±3.48)%after treatment were higher than SBP(109.1 9±8.77)mm Hg and LVEF(39.42±4.68)%before treatment in the experimental group too.The cardiac function of the two groups was also improved after treatment,while the experimental group had greater change than the control group; the difference was statistically significant(P<0.05).Conclusion Levosimendan combined with Alprostadil can effectively reduce PASP of the patients with PH-LHD,improve LVEF and be worthy of clinical application.更多还原