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目的观察左西孟旦联合硫酸特布他林治疗慢性阻塞性肺疾病伴心功能不全的临床疗效及安全性。方法将88例慢性阻塞性肺疾病伴心功能不全患者随机分为对照组44例与试验组44例,2组均给予常规治疗及对症治疗。对照组给予吸入用布地奈德混悬液1 mg+硫酸特布他林雾化液5 mg于射流雾化器内,氧气驱动雾化吸入,每日2次,呋塞米20~40 mg,静脉推注2~3 h。试验组在对照组的基础上给予左西孟旦0.1μg·kg~(-1)·min~(-1)静脉输注,持续给药24 h。2组患者均持续用药7 d。比较2组患者的临床疗效、肌钙蛋白T、心肌酶谱、心肺功能及药物不良反应发生情况。结果治疗后,试验组总有效率为88.64%(39/44例),对照组为70.45%(31/44例,P<0.05)。治疗后,对照组和试验组肌钙蛋白T分别为(0.48±0.06),(0.18±0.03)μg·L~(-1);肌酸激酶分别为(189.29±21.30),(130.27±16.11)U·L~(-1);肌酸激酶同工酶分别为(11.34±1.71),(8.87±1.09)U·L~(-1);乳酸脱氢酶分别为(159.29±17.11),(138.70±14.51)U·L~(-1);左心室舒张末期内径分别为(50.29±5.79),(47.01±5.01)mm;第1秒用力呼气量分别为(1.35±0.19),(1.70±0.23)L;第1秒用力呼气量/用力肺活量(FEV1/FVC)分别为(60.93±7.09)%,(76.94±8.58)%;左心室射血分数分别为(42.39±4.58)%,(51.29±5.71)%;6 min内的最大步行距离分别为(260.39±29.21),(324.29±35.16)m,差异均有统计学意义(均P<0.05)。试验组的药物不良反应有心悸、头痛、眩晕,药物不良反应发生率为6.82%(3/44例);对照组的药物不良反应有体位性低血压、低钠血症、心律失常、口渴,药物不良反应发生率为11.36%(5/44例),差异无统计学意义(P>0.05)。结论左西孟旦联合硫酸特布他林治疗慢性阻塞性肺疾病伴心功能不全的临床疗效较高,安全性高。
Objective To observe the clinical efficacy and safety of levosimendan and terbutaline in the treatment of chronic obstructive pulmonary disease with cardiac dysfunction. Methods Eighty-eight patients with chronic obstructive pulmonary disease and cardiac dysfunction were randomly divided into control group (44 cases) and experimental group (44 cases). Both groups were given routine treatment and symptomatic treatment. The control group was given inhalation of budesonide suspension 1 mg + terbutaline sulphate aerosol 5 mg in the jet nebulizer, inhaled aerosol inhalation, 2 times a day, furosemide 20 ~ 40 mg, intravenous Push 2 ~ 3 h. The experimental group was given levosimendan 0.1μg · kg -1 (-1) · min -1 intravenously on the basis of the control group, and continued to be administered for 24 hours. The patients in both groups continued to receive medication for 7 days. The clinical efficacy, troponin T, myocardial enzymes, cardiopulmonary function and adverse drug reactions in two groups were compared. Results After treatment, the total effective rate was 88.64% (39/44 cases) in the test group and 70.45% (31/44 cases, P <0.05) in the control group. After treatment, the levels of troponin T in control group and experimental group were (0.48 ± 0.06), (0.18 ± 0.03) μg · L -1, creatine kinase were (189.29 ± 21.30), (130.27 ± 16.11) U · L -1 and creatine kinase isozymes were (11.34 ± 1.71) and (8.87 ± 1.09) U · L -1, respectively. Lactate dehydrogenase was (159.29 ± 17.11), ( 138.70 ± 14.51) U · L ~ (-1); the left ventricular end diastolic diameter was (50.29 ± 5.79) and (47.01 ± 5.01) mm respectively; the forced expiratory volume at 1 second was (1.35 ± 0.19) and ± 0.23) L; FEV1 / FVC was (60.93 ± 7.09)% and (76.94 ± 8.58)% respectively; the left ventricular ejection fraction was (42.39 ± 4.58)%, (51.29 ± 5.71)%, respectively. The maximum walking distances within 6 min were (260.39 ± 29.21) and (324.29 ± 35.16) m, respectively, with significant differences (all P <0.05). Adverse reactions to the test group were palpitations, headache, dizziness, adverse drug reactions occurred in 6.82% (3/44 cases); adverse drug reactions in the control group were orthostatic hypotension, hyponatremia, arrhythmia, thirst , The incidence of adverse drug reactions was 11.36% (5/44 cases), the difference was not statistically significant (P> 0.05). Conclusion The combination of levosimendan and terbutaline sulfate in the treatment of chronic obstructive pulmonary disease with cardiac dysfunction has high clinical efficacy and safety.