秦宏杰++陈新光

[摘要] 目的 探討丹参酮ⅡA磺酸钠注射液治疗老年肺源性心脏病的临床效果。 方法 选取2013年6月～2015年6月在首都医科大学附属北京潞河医院就诊的肺心病急性加重期老年患者86例。按随机数字表法将其分为对照组和观察组，每组各43例。两组均给予常规治疗，观察组则在常规治疗的基础上给予静脉滴注丹参酮ⅡA磺酸钠注射液。观察两组患者临床疗效，比较两组患者治疗前后血液流变学各项指标、动脉血气分析及肺动脉收缩压，记录两组患者治疗过程中有无不良反应发生。 结果 观察组总有效率（88.37%）明显高于对照组（76.74%），差异有统计学意义（P < 0.05）。治疗后，两组患者各项血液流变学指标（全血高切黏度、全血低切黏度、血浆黏度、血细胞比容、红细胞聚集指数、血小板聚集率、纤维蛋白原）均明显低于治疗前，差异有统计学意义（P < 0.05）；治疗后，观察组患者上述各项血液流变学指标明显低于对照组，差异有统计学意义（P < 0.05）。与治疗前比较，两组患者治疗后动脉氧分压（PaO2）显著上升，动脉血二氧化碳分压（PaCO2）及肺动脉收缩压均显著降低，差异均有统计学意义（P < 0.05）。治疗后，观察组患者PaO2显著高于对照组，PaCO2及肺动脉收缩压均显著低于对照组，差异有统计学意义（P < 0.05）。两组患者治疗过程中均未见明显不良反应。 结论 丹参酮ⅡA磺酸钠注射液治疗老年肺心病患者效果显著，其能有效减轻患者的临床症状、体征，提高心功能，改善血液流变学和肺动脉高压状态，且安全性高，值得临床推广应用。

[关键词] 肺源性心脏病；丹参酮ⅡA磺酸钠注射液；老年；肺动脉高压；血液流变学

[中图分类号] R541.5 [文献标识码] A [文章编号] 1673-7210（2017）09（b）-0130-04

Clinical effect of Sodium Tanshinone ⅡA Sulfonate Injection in the treatment of senile pulmonary heart disease

QIN Hongjie1 CHEN Xinguang2

1.Department of Emergency， Beijing Luhe Hospital， Capital Medical University， Beijing 101199， China； 2.Department of Emergency， Beijing Puren Hospital， Beijing 100062， China

[Abstract] Objective To investigate the clinical effect of Sodium Tanshinone ⅡA Sulfonate Injection in the treatment of senile pulmonary heart disease. Methods Eighty-six cases of elderly patients with acute stage of pulmonary heart disease treated in Beijing Luhe Hospital， Capital Medical University from June 2013 to June 2015 were selected and divided into control group and observation group by random number table method， with 43 cases in each group. Both groups were given conventional treatment， on basis of which， the observation group was added with Sodium Tanshinone ⅡA Sulfonate Injection， intravenous drip. The clinical effect of the two groups was observed， the indexes of hemorheology， arterial blood gas analysis， pulmonary artery systolic pressure of the two groups before and after treatment were compared， the adverse reactions of the two groups during the course of treatment were recorded. Results The total effective rate of observation group （88.37%） was higher than that of control group （76.74%）， the difference was statistically significant （P < 0.05）. After treatment， the indexes of hemorheology （whole high blood viscosity， whole low blood viscosity， plasma viscosity， hematocrit， red cell assembling index， platelet aggregation rate， fibrinogen） in the two groups were all lower than those before treatment， the differences were statistically significant （P < 0.05）； after treatment， the indexes of hemorheology above in the observation group were all lower than those of control group， the differences were statistically significant （P < 0.05）. Compared with before treatment， the PaO2 of the two groups after treatment were increased， PaCO2 and pulmonary artery systolic pressure were decreased， the differences were statistically significant （P < 0.05）. After treatment， the PaO2 of observation group was higher than that of control group， the PaCO2 and pulmonary artery systolic pressure were lower than those of control group， the differences were statistically significant （P < 0.05）. Both groups had no obvious adverse reactions during the treatment. Conclusion Sodium Tanshinone ⅡA Sulfonate Injection in the treatment of senile pulmonary heart disease has significant effects， which can reduce the clinical signs and symptoms， improve the cardiac function and the states of hemorheology and pulmonary arterial hypertension， and the safety is high， which is worthy of clinical promotion and application.

[Key words] Pulmonary heart disease； Sodium Tanshinone ⅡA Sulfonate Injection； Elderly； Pulmonary arterial hypertension； Hemorheology

慢性肺源性心脏病简称“肺心病”，是由于支气管-肺组织或肺动脉血管慢性病变所致的肺动脉高压，进而引发右心结构和功能改变的心脏病，其临床表现主要为咳嗽、呼吸困难、乏力等，失代偿期可出现呼吸衰竭，伴或不伴心力衰竭[1-2]。慢性肺心病为老年常见病、多发病，其发病率随着年龄的增长而升高，急性加重期以冬、春两季多见，常导致肺、心衰竭，病死率较高，严重影响患者的生活质量，威胁患者的生命安全[3-4]。临床上多采用抗感染、强心、利尿等常规治疗措施，但疗效不甚理想。丹参酮ⅡA磺酸钠是从丹参中分离出丹参酮ⅡA再经过磺化得到的水溶性物质，具有降低肺动脉高压、扩张血管、抑制炎性反应、抗血栓形成、保护心肺功能等作用[5-6]。……