欣康联合低分子肝素钙治疗不稳定型心绞痛100例

自2001年以来。我们应用欣康（单硝酸异山梨醇酯）联合低分子肝素钙治疗不稳定型心绞痛（UA）患者100例，效果满意。现报告如下。     

低分子肝素钙治疗AECOPD合并肺心病的疗效分析

目的探讨低分子肝素钙在治疗慢性阻塞性肺疾病急性加重期（AECOPD）合并肺心病中的临床意义。方法76例诊断为AECOPD合并肺心病的患者分为治疗组40例，对照组36例，两组病人均按常规给予低流量吸氧、抗感染、解痉平喘、止咳祛痰、纠正水电解质失衡、营养支持及必要时予糖皮质激素和呼吸兴奋剂治疗，治疗组加用低分子肝素钙抗凝治疗。结果治疗组治疗10天后全血黏度、血浆黏度、RBC压积、动脉血氧分压和动脉血二氧化碳分压及动脉血氧饱和度好转较对照组明显，治疗组症状开始改善的时间为（5±2）天，住院时间为（11±3）天，对照组症状改善的时间为（8±3）天，住院时间为（17±5）天。结论低分子肝素钙治疗AECOPD合并肺心病可改善患者血液流变学、血气分析、提高肺功能及增强疗效，住院时间缩短，值得临床推广。     

呼吸系统疾病

舒立迭吸入治疗24例支气管哮喘的疗效及诱导痰中炎症介质的变化；广东部分地区慢性阻塞性肺疾病发病状况调查；雾化溶液温度对COPD病人的影响；无创通气佐支气管镜治疗COPD呼衰的临床研究；低分子肝素配伍单硝酸异山梨醇酯治疗肺心病急性加重期44例临床观察。     

单硝酸异山梨酯联合多巴酚丁胺治疗肺心病急性加重期疗效分析

目的：观察单硝酸异山梨酯联合多巴酚丁胺治疗慢性肺源性心脏病（肺心病）急性加重期心力衰竭患者的疗效。方法将138例慢性肺心病心力衰竭患者根据用药情况分为对照组（69例）和治疗组（69例）。治疗组在常规综合治疗的基础上加用单硝酸异山梨酯注射液和多巴酚丁胺注射液。观察两组疗效及动脉血气分析指标、并发症、病死率。结果治疗组疗效明显,并发症、病死率均低于对照组（P〈0.01）。两组疗效比较差异有统计学意义（P〈0.05）。结论单硝酸异山梨酯联合多巴酚丁胺治疗慢性肺心病急性加重期心力衰竭效果显著。     

坎地沙坦联合单硝酸异山梨酯治疗肺心病心力衰竭疗效观察

目的观察坎地沙坦、单硝酸异山梨酯（ISMN）联合治疗重症肺心病心力衰竭的疗效。方法 80例肺心病心力衰竭患者随机分为甲乙两组,每组40例。甲组（治疗组）在乙组常规治疗基础上加坎地沙坦、单硝酸异山梨酯,5 d为1个疗程。结果治疗组显效率71.5%,总有效率90.9%;对照组显效率42.5%,总有效率66.2%,两组显效率、总有效率差异均有统计学意义（均P〈0.01）。结论坎地沙坦、单硝酸异山梨醑（ISMN）合用,治疗老年慢性肺源性心脏病心力衰竭疗效显著,不良反应少,使用安全。     

联合参麦注射液、低分子肝素钙、酚妥拉明治疗肺心病难治性心力衰竭的临床观察

目的探讨联合应用参麦注射液、低分子肝素钙、酚妥拉明治疗肺心病难治性心力衰竭的价值。方法 72例慢性肺心病患者分为治疗组40例,对照组32例。对照组给予常规内科治疗;治疗组在常规治疗基础上联合应用参麦注射液、酚妥拉明,每日1次;低分子肝素钙,1次/12 h,连用7～10 d,观察疗效。结果治疗组疗效明显优于对照组（P〈0.05）。结论参麦注射液、低分子肝素钙、酚妥拉明联合治疗肺心病难治性心力衰竭疗效良好,有较好的临床应用价值。     

低分子肝素联合单硝酸异山梨酯治疗肺心病并心衰疗效观察

目的:探讨低分子肝素联合欣康治疗肺心病并心衰患者的疗效。方法:50例肺心病并心衰患者均采用控制感染、吸氧、改善肺通气功能、纠正水电解质平衡、利尿等治疗措施。研究组38例在此基础上加用低分子肝素钙4100U,1次/12h,脐周皮下注射,并加用单硝酸异山梨酯40 mg+0、9％氯化钠注射液48 ml,以3 ml/h速度通过微泵静脉推注,1次/d,连用10天为1疗程。结果:经治疗研究组32例,显效18例,有效6例,总有效率75％。对照组18例,显效4例,有效4例,总有效率44.4％。两组比较差异有显著性(P<0.05)。治疗组的血气分析及血粘度较对照组改善显著(P<0.05-<0.01)。结论:低分子肝素联合欣康对肺心病并心衰疗效显著。     

低分子肝素钙与硝酸甘油雾化吸入对肺心病急性发作期的临床研究

目的观察硝酸甘油、低分子肝素钙经氧气驱动雾化给药对肺心病急性发作期患者血气分析及肺动脉压力的影响。方法对120例肺心病急性发作期患者分3组：A组：射流雾化吸入硝酸甘油10 mg＋生理盐水2 ml,每日2次,每次15min,疗程7 d;B组：射流吸入低分子肝素钙4100 IU加生理盐水2 ml,每日2次,每次15 min,疗程7 d;C组：硝酸甘油10 mg＋低分子肝素钙4100 IU射流雾化,每日2次,每次15 min,疗程7 d。治疗前后监测动脉血气分析、及肺动脉压力变化情况。结果血气及肺动脉压力的变化每组治疗前后差异均有显著性（P〈0.05）,C组与A、B组比较,PaO2及肺动脉压力改善更明显（P〈0.01）。结论肺心病急性发作期患者联合吸入硝酸甘油与低分子肝素钙,具有改善血气及肺动脉压作用快而直接,能明显缓解血液高粘状态,改善微循环,纠正心肺功能不全效果显著。     

《实用心脑肺血管病杂志》2002年第10卷总目录

论　著　四川省德阳市城市居民脑卒中监测 10年动态分析王安兵　曾晓琼　尹　红等 (10 1 3)…………………　单硝酸异山梨醇酯与低分子肝素钙联合应用治疗肺心病心力衰竭陈　莉　黄　诺　姜向东 (10 1 6 )………　原发性脑干损伤的诊断和治疗张学新　邢鹏辉　刘英姿等 (10 1 8)…………………　呼吸机相关性肺炎的病原学分析与临床研究邵长周　陈小东　张　静等 (10 1 11)…………………　ＮＰ和ＭＶＰ方案治疗晚期非小细胞肺癌的近期疗效比较石　星　杨坤禹 (10 1 15 )………………………………　预处理对在体大鼠心肌细胞的保护作用…     

低分子肝素钙雾化吸人治疗慢性肺源性心脏病的临床研究

目的探讨低分子肝素钙雾化吸入对慢性肺源性心脏病（肺心病）的治疗效果。方法 90例肺心病患者随机分为治疗组与对照组,对照组给予常规治疗,治疗组在常规治疗的基础上应用低分子肝素钙雾化吸入,100IU/kg,q12h,疗程7天。治疗前后监测动脉血气分析、血凝及纤溶指标,治疗后评估疗效。结果临床疗效治疗组优于对照组（P〈0.05）,治疗7天后治疗组血液流变学指标明显改善,PaO2明显上升,PaCO2明显下降,血液学指标变化不明显。结论低分子肝素钙雾化吸入可明显改善肺心病患者的血液粘稠度和肺通气功能,给药方便,安全有效。     

静滴川芎嗪并雾化吸入低分子肝素钙治疗慢性肺心病疗效观察

目的探讨静滴川芎嗪并雾化吸入低分子肝素钙治疗慢性肺源性心脏病（简称肺心病）的价值。方法 60例肺心病急性加重期住院患者,随机分为治疗组与对照组,对照组给予常规治疗,治疗组在常规治疗的基础上,加用川芎嗪静滴并低分子肝素钙雾化吸入。结果治疗10天后,治疗组较对照组血液流变学指标明显改善,PaO2明显上升,PaCO2明显下降。治疗组临床总有效率93.3%,明显高于对照组76.7%（P〈0.05）。结论静滴川芎嗪并雾化吸入低分子肝素钙可明显改善肺心病患者的血液粘稠度和肺通气功能,提高临床总有效率,给药方便、安全有效。     

低分子肝素钙治疗慢性肺源性心脏病急性发作期64例疗效观察

目的评价低分子肝素钙治疗慢性肺源性心脏病（肺心病）急性发作期的疗效及安全性。方法选择我院慢性肺心病急性发作患者124例，随机分为两组，两组患者均根据药物敏感试验选择有效性抗生素，扩血管、强心利尿，止咳化痰，低流量持续吸氧，维持水电解质平衡等常规治疗，治疗组患者在此基础上加用低分子肝素钙4100U，2次／d，腹部皮下注射，疗程均为7d。观察两组患者的临床疗效及有无出血、药物过敏等不良反应。结果两组患者的临床疗效间差异有非常显著性意义（P〈0．01）。治疗组患者治疗前、后血浆黏度、全血黏度低切间差异均有显著性意义（P〈0．05），且无严重不良反应。结论低分子肝素钙治疗肺心病急性发作期安全有效。     

Central and regional hemodynamic effects of intravenous isosorbide dinitrate, nitroglycerin and nitroprusside in patients with congestive heart failure

A triple crossover random design was used to compare the central and regional hemodynamic effects of intravenous isosorbide dinitrate, nitroglycerin and nitroprusside in 10 patients with low output congestive heart failure. Isosorbide dinitrate and nitroglycerin were infused in dose increments of 0.8 μg/kg body weight per min up to 4.0 μg/kg per min and nitroprusside in increments of 0.4 μg/kg per min up to 2.0 μg/kg per min. The central and regional hemodynamic responses of isosorbide dinitrate and nitroglycerin were similar;both effected a 10 to 35 percent reduction in pulmonary capillary wedge pressure, systemic blood pressure and vascular resistance and pulmonary arterial pressure and resistance with a 7 to 22 percent increase in stroke volume and cardiac output. Nitroprusside elicited a similar decrease in pulmonary capillary wedge pressure with a greater reduction (15 to 45 percent) in systemic blood pressure and resistance and pulmonary arterial pressure and resistance and greater augmentation of stroke volume and cardiac output (20 to 40 percent). Arterial oxygen saturation remained unchanged with isosorbide dinitrate and nitroglycerin and decreased slightly with nitroprusside. None of the drugs altered total body oxygen consumption. All three drugs decreased limb vascular resistance and elevated limb blood flow proportional to the degree of change in systemic vascular resistance and cardiac output. Isosorbide dinitrate and nitroglycerin did not alter renal vascular resistance, so that a mild reduction in renal blood flow was noted as systemic blood pressure decreased. Nitroprusside decreased renal vascular resistance; however, the concomitant decrease in arterial pressure resulted in no net change in renal blood flow. None of the three drugs altered hepatic blood flow or vascular resistance.

In low output congestive heart failure, these three drugs effect similar responses in preload, nitroprusside causing a greater change in afterload. Preferential vasodilation of regional vascular beds was noted with limb flow greater than hepatic and renal flow with isosorbide dinitrate and nitroglycerin and limb flow much greater than renal and greater than hepatic flow with nitroprusside.     

单硝酸异山梨酯注射液治疗慢性支气管炎合并慢性肺源性心脏病160例疗效分析

目的　探讨单硝酸异山梨酯注射液 (鲁南欣康注射液 )在治疗慢性支气管炎 (简称慢支 )并慢性肺源性心脏病 (简称慢性肺心病 )的临床效果。方法　 10 0例慢支合并慢性肺心病患者使用抗炎、解痉、化痰、强心利尿等常规治疗作对照组 ;另一组 16 0例为治疗组 ,即在此基础上加用鲁南欣康注射液 ,观察两组心功能改善、动脉血Pa O2 增加、Pa CO2 减少、Sa O2 增加情况。结果　治疗组总有效率明显优于对照组 ,其疗效有非常显著差异 (P<0 .0 1)。结论　鲁南欣康注射液在治疗慢支并慢性肺心病的过程中可以有效改善心功能 ,并且影响整个病情的预后 ,副作用小 ,价格便宜 ,值得推广。     

Haemodynamic effects of oral salbutamol alone and in combination with sublingual isosorbide dinitrate in patients with severe congestive cardiac failure.

To examine possible augmentation of the effects of isosorbide dinitrate by salbutamol, haemodynamic measurements were made in 10 patients with severe chronic congestive cardiac failure who received isosorbide dinitrate 2.5 to 25 mg sublingually and salbutamol 4 to 12 mg orally, alone and in combination. Isosorbide dinitrate reduced mean left ventricular filling pressure from 29 to 18 mmHg and increased mean cardiac index from 1.7 to 2.0 1/min per m2, with no significant change in mean heart rate. Systemic arterial mean pressure fell from 85 to 72 mmHg. Salbutamol increased cardiac index from 1.8 to 2.2 1/min per m2. There was no significant change in left ventricular filling pressure, heart rate, or systemic arterial pressure. Compared with control, combined isosorbide dinitrate and salbutamol reduced left ventricular filling pressure from 27 to 19 mmHg and increased cardiac index from 1.8 to 2.7 1/min per m2, with no significant change in heart rate. Systemic arterial pressure fell from 82 to 75 mmHg. The reduction in left ventricular filling pressure by combined treatment was similar to that produced by isosorbide dinitrate alone, but the increase in cardiac index was significantly greater than that produced either by isosorbide dinitrate alone or salbutamol alone. Combined sublingual isosorbide dinitrate and oral salbutamol have an additive effect in improving left ventricular performance in patients with severe chronic congestive cardiac failure.     

米力农治疗慢性肺源性心脏病合并心力衰竭的临床疗效观察

目的 观察米力农治疗慢性肺源性心脏病合并心力衰竭的临床疗效.方法 46例慢性肺源性心脏病合并心力衰竭患者,随机分为常规治疗组（CT,n=23）和米力农治疗组（MT,n=23）.CT组采用吸氧、抗感染、怯痰平喘等治疗,MT组在CT组治疗法方案的基础上加用米力农,7d为1疗程.观察治疗后两组6 min步行试验（6MWT）距离、脑钠肽（BNP）水平,同时采用彩色多普勒超声心动图测定静息状态下平均肺动脉压（mPAP）、心输出量（CO）的变化.结果 MT组6MWT高于CT组[（299.3±89.5）m vs.（243.2±68.8）m,P＜0.05],CO也显著高于CT组[（4.1±0.9）L/min vs.（3.6±1.3）L/min,P＜0.05]; 同时,MT组BNP低于CT组[（332±136）ng/L vs.（485±102）ng/L,P＜0.05],mPAP也低于CT组[（32.3±7.6）mmHg vs.（38.2±6.2）mmHg,P＜0.05].结论 米力农治疗可改善慢性肺源性心脏病合并心力衰竭患者的运动耐量及心功能,且可降低肺动脉压.     

低分子肝素佐治充血性心力衰竭的临床研究

目的探讨低分子肝素对充血性心力衰竭患者心功能、凝血功能的影响。方法将62例慢性心力衰竭患者随机分为两组,对照组31例给予强心、利尿、扩血管、p受体阻滞剂、血管紧张素转换酶抑制剂、醛固酮受体拮抗剂等常规治疗;治疗组31例在此基础上加用低分子肝素5000U／次皮下注射,2次／d,共15d,2周后检查心脏超声。评估心功能、测定血浆D一二聚体,血浆纤维蚤白原水平。结果两组治疗后左室舒张末径（LVEDd）水平明显降低,左室射血分数（LVEF）水平明显升高,与治疗前比较差异有统计学意义（P〈0．05）;并且治疗组治疗后LVEDd、LVEF水平改善明显优于对照组,两组比较差异有统计学意义（P〈0．05）;治疗组血浆D-二聚体、血浆纤维蛋白原（FPG）水平明显降低（P〈0．05）。结论低分予肝素既能降低血浆D—dimer、FPG水平,又可改善充血性心力衰竭心脏功能,有益于充血性心力衰竭的治疗。     

Effect of isosorbide dinitrate on response to submaximal and maximal exercise in patients with congestive heart failure.

Isosorbide dinitrate is an effective vasodilator that improves resting left ventricular performance in patients with congestive heart failure, but little is known of the effect of the drug on the response to exercise. Bicycle exercise to symptomatic maximum was performed by 18 patients with class II to IV congestive heart failure before and 90 minutes after administration of isosorbide dinitrate, 40 mg orally. Although resting pulmonary wedge pressure and systemic vascular resistance were significantly reduced after isosorbide dinitrate, exercise duration was not altered and maximal oxygen consumption was not significantly changed (13.6 +/- 1.3 [SEM] standard error of the mean versus 13.8 +/- 1.2 ml/kg per min). At peak exercise pulmonary wedge pressure of 37.1 +/- 1.7 mm Hg, cardiac index of 4.19 +/- 0.35 liters/min per m2, and systemic vascular resistance of 14.7 +/- 1.3 units were not significantly different after nitrate administration. However, at submaximal loads, pulmonary wedge pressure was reduced from 33.6 +/- 1.7 to 27.9 +/- 1.8 mm Hg (P less than 0.01), and systemic resistance from 16.5 +/- 1.5 to 13.7 +/- 1.0 units (P less than 0.01) after administration of isosorbide dinitrate. Thus, short-term administration of nitrates does not improve maximal exercise capacity or left ventricular performance at maximal exercise in patients with congestive heart failure, but it does appear to improve pump function at submaximal work loads and may therefore enable patients to perform limited exercise more comfortably.     

低分子肝素钙联合普米克令舒吸入治疗AECOPD98例临床观察

目的观察低分子肝素钙与普米克令舒联合吸入治疗慢性阻塞性肺疾病急性加重期（AECOPD）的疗效。方法 AECOPD病人98例,按随机数分配法分为治疗组52例,对照组46例,两组病人均给予常规治疗,治疗组在常规治疗的基础上加用低分子肝素钙联合普米克令舒吸入治疗。观察治疗前后以及组间临床症状改善情况,各项指标的变化。结果两组临床症状评分、平均住院日比较差异有统计学意义（P均〈0.05）,治疗组临床疗效明显优于对照组,差异有统计学意义（u=2.692,P=0.007）。治疗后两组血气分析、肺功能均比治疗前改善,差异有统计学意义（P〈0.01）,治疗组改善程度大于对照组,差异有统计学意义（P〈0.05）。结论低分子肝素钙与普米克令舒联合吸入治疗AECOPD,临床疗效确切,值得推广应用。     

慢性肺心病合并冠心病41例临床分析

目的 探讨慢性肺心病（肺心病）合并冠心病的临床特点.方法 对41例肺心病合并冠心病患者（肺冠合并组）和30例单纯肺心病（单纯肺心组）进行临床比较、统计、分析临床特点及诊断方法.结果 在易患因素上,两组在长期吸烟、高血压、高脂血症、肥胖等有显著性差异（P＜0.05或P＜0.01）.在临床表现方面,其左心室肥大、双心室增大、合并左束枝传导阻滞,持续ST-T改变等均有显著性差异（P＜0.01）.结论 慢性肺心病患者如伴有高血压、糖尿病、肥胖、左心室肥大、持续ST-T改变,心梗/左心衰时,在排除少数相关疾病后即可临床诊断为肺心病合并冠心病.