【摘要】 目的研究外源性NO供体——硝酸异山梨酯(消心痛)对慢性阻塞性肺疾病(COPD)伴心力衰竭患者心肺功能的短期和长期影响。方法27例患者随机分为两组,其中14例COPD伴心力衰竭患者分别进行短期和长期试验,静脉滴注消心痛和口服消心痛缓释剂;与同期13例COPD伴心衰患者作对照观察(其中2例失访,被排除)。分别测量治疗前后患者血气、血流动力学参数、左右心功能和肺功能指标变化。结果(1)即刻效应:静滴消心痛后,平均肺动脉压(mPAP)即由(31.57±8.34)mm Hg降至(23.00±8.41)mm Hg(P<0.01),平均主动脉压(PAO)由(86.03±12.86)mm Hg降至(80.69±11.89)mm Hg(P<0.05),PaO2升高(P<0.05)。(2)短期影响:静滴消心痛1周后,mPAP由(32.74±10.16)mm Hg降至(26.28±9.26)mm Hg(P<0.01),而体循环压无明显变化;动脉和混合静脉血血氧分压明显改善,左右心功能指标亦明显改善。(3)长期影响:口服消心痛缓释剂1年后,患者mPAP无明显变化,而对照组患者mPAP由(21.64±4.11)mm Hg上升至(23.97±4.47)mm Hg(P<0.05);随访1年,治疗组肺功能无明显变化,但氧耗量由(203.54±42.09)mL/min降至(179.77±37.15)mL/min(P<0.01),患者左右心功能指标明显改善,右心形态结构参数亦有改善。结论外源性NO供体对COPD伴心力衰竭患者短期有降低肺动脉压力,改善氧合的作用;长期则有降低耗氧量,改善左右心功能的作用。更多还原

【Abstract】 Objective To investigate the short-and long-term effects of extragenous nitric oxide donor,isosorbide dinitrate,on cardiorespiratory function in patients with chronic obstructive pulmonary disease(COPD) and heart failure.Methods Twenty-seven patients enrolled in this trial were randomized to short-term and long-term treatment of Isosobide dinitrate or Isosorbide Mononitrate in addition to conventional therapy(experimental group,n=14) or conventional therapy alone(control group,n=13).The parameters of blood gases and hemodynamics,left and right heart function and lung function were measured before and after treatment.Results(A)Immediate haemodynamic response:infusing Isosobide dinitrate reduced mean pulmonary artery pressure(mPAP) from(31.57±8.34)mm Hg to(23.00±8.41)mm Hg(P<0.01) while mean aortic pressure(PAO) from(86.03±12.86)mm Hg to(80.69±11.89)mm Hg(P<0.05).The PaO2 elevated significantly(P<0.05).(B)Short-term effects:infusing Isosobide dinitrate for one week reduced mPAP from(32.74±10.16)mm Hg to(26.28±9.26)mm Hg(P<0.01),but PAO did not change significantly.The pressure of O2 in arterial and mixed vein blood as well as heart function parameters were also improved significantly.(C)Long-term effects:the one year oral Isosorbide mononitrate reduced oxygen consumption(O2) from(203.54±42.09)mL/min to (179.77±37.15)mL/min,but did not change mPAP and lung function significantly.However,the one year conventional therapy increased mPAP from(21.64±4.10)mm Hg to(23.96±4.47)mm Hg(P<0.05).The one year oral Isosorbide Mononitrate had beneficial effects on right ventricular size and parameters of left and right heart function.Conclusions The extragenous nitric oxide donor may reduce mPAP and improve tissue O2 levels of patients with COPD and heart failure for a short term and has beneficial effects on heart structure and function due to a reduction in O2 for a long term.更多还原