比索洛尔与卡维地洛对心力衰竭合并慢性阻塞性肺疾病患者心肺功能及血清学指标的影响

目的 探讨比索洛尔与卡维地洛对心力衰竭合并慢性阻塞性肺疾病（COPD）患者心肺功能及血清学指标的影响。方法 选取2017年3月—2019年3月河南科技大学附属许昌市中心医院82例心力衰竭合并COPD患者作为研究对象，根据随机抽签原则将患者分为对照组（41例）和观察组（41例）。对照组患者在常规治疗的基础上口服卡维地洛片，初始剂量为2.5 mg/次，之后根据患者具体病情及耐受性可逐渐增加，体质量在85 kg以内者最大剂量为20 mg/次，2次/d；体质量在85 kg以上者最大剂量为50 mg，2次/d。观察组患者在常规治疗的基础上口服富马酸比索洛尔片，初始剂量为1.25 mg/次，1次/d，连续服用7 d后可增加至2.5 mg/次，1次/d；之后在依次增加至5 mg/次，1次/d，1个月增加至7.5 mg/次，1次/d，再持续治疗1个月后根据患者的耐受情况增加至10 mg/次，1次/d。两组均连续治疗3个月。观察两组患者治疗前后的心肺功能指标、血清学指标和不良反应发生情况。结果 治疗后，两组患者左心射血分数（LVEF）和6 min步行距离（6 MWD）均显著升高，左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）明显降低（P<0.05）；且观察组治疗后各心功能指标显著优于对照组（P<0.05）。治疗后，两组患者第1 s用力呼气量（FEV₁）、用力肺活量（FVC）、呼气峰流速（PEF）、最大呼气中期流速（MMEF）和FEV₁/FVC水平均明显升高（P<0.05）；且观察组各肺功能指标显著高于对照组（P<0.05）。治疗后两组患者白细胞介素-6（IL-6）C反应蛋白（CRP）、内脂素、脑钠肽（BNP）及N末端B型利钠肽原（NT-proBNP）水平均明显降低（P<0.05）；且观察组血清学指标水平显著低于对照组（P<0.05）。治疗期间，观察组患者不良反应发生率显著低于对照组，两组比较存在统计学差异（P<0.05）。结论 与卡维地洛相比，比索洛尔更有利于抑制机体炎性反应，改善其心肺功能，且不良反应少，对控制心力衰竭合并COPD病情进展，对促进病情康复具有积极意义。

Effect of bisoprolol and carvedilol on cardiopulmonary function and serological index in patients with heart failure complicated with COPD

Objective To investigate the effect of bisoprolol and carvedilol on cardiopulmonary function and serologic indexes in patients with heart failure complicated with COPD. Methods A total of 82 patients with heart failure complicated with COPD in Xuchang Central Hospital Affiliated to Henan University of Science and Technology from March 2017 to March 2019 were selected as study subjects, and the patients were divided into control group (41 cases) and observation group (41 cases) according to the principle of random lottery. Patients in the control group po administered with Carvedilol Tablets on the basis of conventional treatment, the initial dose was 2.5 mg/time, then gradually increased according to the patient''s specific condition and tolerance. The maximum dose of weight less than 85 kg was 20 mg/time and twice daily, the maximum dose of 85 kg or more was 50 mg/time, twice daily. Patients in the observation group were po administered with Bisoprolol Fumarate Tablets on the basis of conventional treatment, the initial dose was 1.25 mg/time, once daily, which could be increased to 2.5 mg/time, once daily after continuous 7 days. After that, it was successively increased to 5 mg/time, once daily. Then 7.5 mg/time, once daily for 1 month, and increased to 10 mg/time, once daily according to the patient''s tolerance after 1 month of continuous treatment. Both groups were treated continuously for 3 months. After treatment, the cardiopulmonary function, serological index, and adverse reactions in two groups before and after treatment were observed. Results After treatment, LVEF and 6 MWD were significantly increased in two groups, while LVESD and LVEDD were decreased (P<0.05). And the cardiac function indexes in the observation group were significantly better than those in the control group (P<0.05). After treatment, FEV₁, FVC, PEF, MMEF, and FEV₁/FVC levels were significantly increased in two groups (P<0.05). And the lung function indexes in the observation group were significantly higher than those in the control group (P<0.05). After treatment, the levels of IL-6, CRP, endoliptin, BNP, and NT-proBNP in two groups were significantly decreased (P<0.05). And the serological indexes level in the observation group were significantly lower than those in the control group (P<0.05). During treatment, the incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). Conclusion Compared with carvedilol, bisoprolol is more conducive to inhibiting the body''s inflammatory response and improving its cardiopulmonary function, with fewer adverse reactions, which is of positive significance for controlling the progression of heart failure complicated with COPD, and promoting the rehabilitation of the disease.