ARBs与ACEI治疗重度COPD合并慢性肺源性心脏病疗效  

Comparation of ARBs and ACEI in treating severe COPD combined with chronic pulmonary heart disease

作　　者：冯曙平[1] 谭锦志[1] 

机构地区：[1]广州医学院荔湾医院呼吸内科,广东广州510170

出　　处：《临床医学》2012年第9期1-3,共3页Clinical Medicine

摘　　要：目的重度慢性阻塞性肺疾病(COPD)晚期多合并慢性肺源性心脏病,多数患者全身状态差,血压不高或偏低,合并右心功能不全,治疗难度大。探讨肾素-血管紧张素-醛固酮系统(RAS)抑制剂:血管紧张素转换酶抑制剂(ACEI),血管紧张素受体阻滞剂(ARBs)的疗效。方法选择重度COPD合并肺心病患者83例,随机分为A、B、C三组。在控制感染、平喘、强心、氧疗、使用安体舒通等基础上,A组加用ARBs缬沙坦片20～40 mg,1次/d。B组加用ACEI贝那普利片2.5～5.0 mg,1次/d。C组加用单硝酸异山梨酯缓释片40 mg,1次/d,作为对照组。疗程均为4周。观察三组治疗有效率,不良反应,治疗前后CAT评分、血压、心率。结果有效率:A组高于B组与C组(P<0.05)。A组的咳嗽、低血压出现例数比B组少。经方差分析,治疗后CAT评分A组<B组<C组,差异有统计学意义(P<0.05)。治疗后A组血压、心率较稳定。结论对于一些重度COPD合并肺心病患者,使用ARBs治疗可获得较好的效果,值得临床推广。Objective Advanced severe chronic obstructive pulmonary disease （COPD） mostly combined with chronic pul- monary heart disease, most patients in poor healthy condition, the blood pressure are not high or lower, and with right heart fail- ure. The treatment is difficult. The research is aimed to explore the clinical effects by using renin-angiotensin-aldosterone system （ RAS ） inhibitors： angiotensin-eonverting enzyme inhibitors （ ACEI ） and angiotensin receptor blockers （ ARBs ）. Methods Eighty-three patients with severe COPD combined with chronic pulmonary heart disease were elected in random. They were randomly divided into groups A, B and C. All groups in the control infection, control asthma, cardiac, oxygen, therapy spi- ronolaetone use on the basis of such. Group A takes ARBs valsartan tablets 20 -40 mg qd. Group B takes ACEI henazepril tab- lets 2. 5 -5 mg qd. Group C takes isosorbide mononitrate sustained release tablets 40mg qd as the control group. The course of treatment lasted 4 weeks. Observed the treatment efficiency, adverse reactions, COPD Assessment Test（CAT）score, blood pres- sure, heart rate of three groups before and after treatment. Results Treatment efficiency in group A was higher than group B and C （ P 〈 0. 05 ）. The number of cases such as cough, low blood pressure occurs in group A were less than in group B. CAT score in group A was less than group B, group B was less than group C after treatment （Analysis of variance） , P 〈0. 05. After treat- ment, blood pressure, heart rate in group A is more stable. Conclusion For some with severe COPD with pulmonary heart disease, treatment with ARBS gets good results, it is worth promoting.

关 键 词：重度慢性阻塞性肺疾病 慢性肺源性心脏病 血管紧张素受体阻滞剂 血管紧张素转换酶抑制剂I CAT评分 AgⅡ逃逸 

分 类 号：R541.5[医药卫生—心血管疾病]