中西医结合治疗慢性肺源性心脏病失代偿期疗效观察及对肺功能和血液流变学指标的影响

目的观察中西医结合治疗慢性肺源性心脏病(以下简称肺心病)失代偿期的疗效,并探讨其对患者肺功能及血液流变学指标的影响。方法将200例肺心病失代偿期患者随机分为2组。治疗组132例,在西医常规治疗基础上加用消肿定喘汤中西医结合治疗;对照组68例,单纯予西医常规治疗。2组均以14 d为1个疗程,比较治疗前后患者主要症状、体征改善情况,包括咳嗽、呼吸困难、心悸、紫绀、下肢水肿及肝脏大;肺功能指标变化,包括用力肺活量(FVC)、第1 s用力呼气容积(FEV1)、FEV1/FVC;动脉血氧分压p(O_2)]及二氧化碳分压p(CO_2)];血液流变学指标变化,包括全血比黏度(100/s、35/s、10/s及5/s)、红细胞沉降率、红细胞比容及纤维蛋白原。结果经Ridit分析,治疗组疗效优于对照组(P0.05);治疗组治疗后主要症状、体征改善率均高于对照组(P0.05);治疗组治疗后各肺功能指标均高于本组治疗前及对照组治疗后(P0.05),对照组治疗前后各肺功能指标无明显变化(P0.05);治疗组治疗后可明显提高p(O_2)水平,降低p(CO_2)水平,与本组治疗前及对照组治疗后比较差异均有统计学意义(P0.05),对照组治疗后仅p(O_2)水平与本组治疗前有明显升高(P0.05);治疗组治疗后各血液流变学指标均低于本组治疗前及对照组治疗后(P0.05),对照组各血液流变学指标治疗前后无明显变化(P0.05)。结论在西医常规治疗的基础上加用消肿定喘汤治疗肺心病失代偿期可明显提高临床疗效,改善患者临床症状、体征及肺功能,升高p(O_2)水平,降低p(CO_2)水平,改善患者血液流变学指标,提高肺通气功能,改善组织器官的缺氧状况。

Observation of the influence of combined therapy of traditional Chinese and western medicine in pulmonary function and hemorheology parameters on chronic pulmonary heart disease decompensation period and its effects

Objective To observe the effect of combined therapy of traditional Chinese and western medi-cine on the treatment of chronic pulmonary heart disease(COPD)decompensation period,and the influence of pul-monary function and hemorheology parameters. Methods 200 COPD patients in decompensation period were ran-domly divided into two groups. 132 patients in treatment group were treated by Xiaozhong - dingchuan decoction on the basis of western routine treatment. 68 patients in control group were treated by simple western routine treatment. The treatment course was 14 d in two groups. The main symptoms and signs including cough,dyspnea,palpitation, cyanosis,edema in lower extremities and hepatomegaly before and after treatment were compared. The changes of pulmonary function parameters including forced vital capacity(FVC),forced expiratory volume 1 second(FEV1 ), FEV1 / FVC ratio and the arterial partial pressure of oxygenp(O2 )]and partial pressure of CO2p(CO2 )]were observed,as well as the hemorheology indexes including whole blood viscosity(100 / s,35 / s,10 / s,5 / s),erythro-cyte sedimentation rate(ESR),hematocrit value(HCT)and fibrinogen. Results The curative effect in treatment group was superior to that in control group according to Ridit analysis(P ﹤ 0. 05). The improvement rates of main symptoms and signs after treatment in treatment group was superior to those in control group(P ﹤ 0. 05). The pulmo-nary functions parameters after treatment in treatment group were increased and the increase was higher than that in control group(P ﹤ 0. 05). There were no significant changes on pulmonary function parameters before and after treat-ment in control group(P ﹥ 0. 05). The level of p(O2 )after treatment in treatment group was significantly increased,and the p(CO2 )was decreased,which compared with before treatment showed statistical difference. There was statistical difference on the p(O2 )and p(CO2 )after treatment between treatment and control group(P ﹤ 0. 05). There only p (O2 )level was increased after treatment in control group(P ﹤ 0. 05). The hemorheology indexes after treatment in treatment group were lower than those in before treatment and control group(P ﹤ 0. 05). There were no statistical differences on hemorheology indexes between before and after treatment in control group(P ﹥ 0. 05). Conclusion Combined therapy of Xiaozhong - dingchuan decoction and western routine treatment can significantly improve the therapeutic effects,improve the clinical symptoms and signs of COPD patients in decompensation period,improve pulmonary function,increased p(O2 )level,decreased p(CO2 )level,improve the hemorheology indexes,enhance pulmonary ventilation function,improve the hypoxia of tissues and organs.