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目的评价酚妥拉明、多巴胺和醒脑静治疗慢性肺源性心脏病(肺心病)急性期的临床疗效。方法239例慢性肺心病急性发作期患者随机分为3组:Ⅰ组:给予氧疗、平喘、祛痰、抗感染、利尿、强心及糖皮质激素等常规治疗。Ⅱ组:不用利尿、强心药,加用酚妥拉明及多巴胺。Ⅲ组:在Ⅱ组治疗基础上加用醒脑静注射液静脉滴注。对各组临床疗效进行对比分析。结果总有效率:Ⅰ组59.1%,Ⅱ组89.2%,Ⅲ组100%。Ⅱ组和Ⅲ组总有效率均明显高于Ⅰ组(均为P<0.01);Ⅱ组和Ⅲ组相比差异有显著性(P<0.05)。住院病死率:Ⅰ组为20.5%,Ⅱ组为2.4%,Ⅲ组为0。Ⅱ组和Ⅲ组均低于Ⅰ组(均为P<0.01)。肺性脑病病死率:Ⅰ组为55.6%,Ⅱ组为50.0%,Ⅲ组为0。Ⅰ组、Ⅱ组与Ⅲ组比较,差异有显著性(P<0.01)。结论酚妥拉明、多巴胺及醒脑静联合用于慢性肺心病急性加重期,特别是合并肺性脑病的患者,其综合疗效明显优于长期沿用的传统疗法。
Objective To evaluate the clinical efficacy of phentolamine, dopamine and xingnaojing in the treatment of acute pulmonary heart disease (pulmonary heart disease). Methods A total of 239 patients with chronic pulmonary heart disease were randomly divided into three groups: Group Ⅰ: conventional therapy including oxygen therapy, asthma, expectorant, anti-infective, diuretic, cardiac and glucocorticoid. Group Ⅱ: no diuretic, cardiac drugs, plus phentolamine and dopamine. Group Ⅲ: On the basis of group Ⅱ, XNX injection was given intravenously. The clinical efficacy of each group were compared. The total effective rate was 59.1% in group Ⅰ, 89.2% in group Ⅱ and 100% in group Ⅲ. The total effective rates of group Ⅱ and group Ⅲ were significantly higher than those of group Ⅰ (all P <0.01). There was significant difference between group Ⅱ and group Ⅲ (P <0.05). In-hospital mortality was 20.5% in group I, 2.4% in group II and 0 in group III. Group Ⅱ and group Ⅲ were lower than group Ⅰ (all P <0.01). The mortality of pulmonary encephalopathy was 55.6% in group Ⅰ, 50.0% in group Ⅱ and 0 in group Ⅲ. The difference between group Ⅰ, group Ⅱ and group Ⅲ was significant (P <0.01). Conclusion Combined use of phentolamine, dopamine and xingnaojing for acute exacerbation of chronic pulmonary heart disease, especially in patients with pulmonary encephalopathy, the comprehensive efficacy was significantly better than long-term use of traditional therapies.