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  本文選題：慢性血栓栓塞性肺動脈高壓 + 療效觀察　； 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:本文通過分析16例應用波生坦治療的慢性血栓栓塞性肺動脈高壓(CTEPH)患者的臨床資料,總結波生坦治療CTEPH的有效性和安全性。方法:采用回顧性研究方法進行研究。研究對象為2014年1月至2016年8月就診于山西醫(yī)科大學第一醫(yī)院呼吸內科接受波生坦治療的CTEPH患者,將16例符合入選標準、無排除標準的CTEPH患者納入研究。收集入選患者波生坦治療前與治療6月后的臨床資料并分為兩組,比較治療前后兩組觀察指標的變化情況,總結波生坦治療CTEPH的臨床療效和安全性。療效評估指標包括:6分鐘步行距離(6MWD)、Borg呼吸困難指數(shù)評分、WHO心功能分級及NT-proBNP,動脈血氣分析指標:PaO2和PaCO2,超聲心動圖指標:肺動脈收縮壓(PASP)、三尖瓣反流速度(TRV)、右心室前后徑、心包積液發(fā)生率;安全性評估指標包括:肝功能和血細胞分析,同時記錄頭痛、面部潮紅、胃腸道反應等其他不良反應。結果:治療后CTEPH患者的運動耐力和呼吸困難明顯改善,6MWD由治療前(324.8±116.4)m增加至(357.3±104.6)m;Borg呼吸困難指數(shù)評分由治療前(3.27±1.19)降至(2.14±0.73),兩組比較差異均有統(tǒng)計學意義(均P0.05)。治療后患者WHO心功能分級較治療前顯著降低,兩組比較差異有統(tǒng)計學意義(P0.05)。NT-proBNP水平由治療前(1869.79±793.62)pg/ml降低至(836.21±294.32)pg/ml,兩組比較差異有統(tǒng)計學意義(P0.05)。動脈血氣分析結果顯示:PaO22由治療前(53±3.7)mmHg升高至(78±6.3)mmHg,兩組比較差異具有統(tǒng)計學意義(P0.05);PaCO2治療前后分別為(37±6.4)mmHg和(41±2.3)mmHg,兩組比較差異無統(tǒng)計學意義(P0.05)。超聲心動圖結果提示:PASP由治療前(80.1±26.3)mmHg降低至(63.4±22.7)mmHg,TRV由治療前(4.5±0.69)cm/s降低至(3.7±0.87)cm/s,心包積液發(fā)生率由治療前43.75%下降至18.75%,兩組比較差異均有統(tǒng)計學意義(均P0.05);治療前后右心室前后徑分別為(28±4.7)mm和(25±3.6)mm,兩組比較差異無統(tǒng)計學意義(P0.05)。治療期間1例患者出現(xiàn)轉氨酶輕度升高,1例患者出現(xiàn)輕微頭痛、面部潮紅,無患者因不良反應停止用藥。結論:波生坦可明顯提高CTEPH患者的運動耐力,顯著改善患者低氧血癥及心功能分級,并有效降低患者肺動脈高壓和改善右心室功能狀態(tài)。CTEPH患者對波生坦治療的整體耐受性良好,臨床應用較為安全�？傊�,波生坦是治療CTEPH的一種有效且安全的臨床手段。
[Abstract]:Objective: to analyze the clinical data of 16 patients with chronic thromboembolic pulmonary hypertension (CTEPH) treated with Bosentam, and to summarize the efficacy and safety of Bosentam in the treatment of CTEPH. Methods: retrospective study was carried out. From January 2014 to August 2016, 16 patients with CTEPH who were treated by Bosentan in Department of Respiratory, first Hospital of Shanxi Medical University were included in the study. 16 CTEPH patients who met the inclusion criteria and had no exclusion criteria were included in the study. The clinical data before and after treatment were collected and divided into two groups. The changes of observation indexes before and after treatment were compared and the clinical efficacy and safety of Bosentam in treating CTEPH were summarized. The evaluation of therapeutic effect included 6 minutes walking distance and 6 MW DX Borg dyspnea index score, WHO cardiac function grade and NT-proBNPs, arterial blood gas analysis indexes: Pao 2 and Paco 2, echocardiography: pulmonary artery systolic pressure, tricuspid regurgitation velocity and TRVV, right ventricular anteroposterior diameter, right ventricular anterior and posterior diameters, echocardiographic parameters: pulmonary artery systolic pressure, tricuspid regurgitation velocity, right ventricular anteroposterior diameter. Incidence of pericardial effusion and safety assessment included liver function and blood cell analysis, and other adverse reactions such as headache, facial flashes, gastrointestinal reactions and so on. Results: after treatment, the dyspnea and dyspnea of patients with CTEPH improved significantly from 324.8 鹵116.4mm to 357.3 鹵104.6mBorg dyspnea index from 3.27 鹵1.19 to 2.14 鹵0.730.The difference between the two groups was statistically significant (P 0.05). After treatment, the WHO cardiac function grade was significantly lower than that before treatment. The difference between the two groups was statistically significant. The level of NT-proBNP decreased from 186.79 鹵793.62)pg/ml to 836.21 鹵294.32 PG / ml. The difference between the two groups was statistically significant (P 0.05). Arterial blood gas analysis showed that the blood gas level of the two groups increased from 53 鹵3.7)mmHg to 78 鹵6.3mm Hg.The difference between the two groups was statistically significant (P 0.05): P0.05 鹵Pao 2 was 37 鹵6.4)mmHg and 41 鹵2.3 mm Hg, respectively. There was no significant difference between the two groups (P 0.05). The results of echocardiography showed that the volume of 26.3)mmHg decreased from 80.1 鹵26.3)mmHg to 63.4 鹵22.7mm before treatment from 4.5 鹵0.69)cm/s to 3.7 鹵0.87cm / s, and the incidence of pericardial effusion decreased from 43.75% to 18.75 cm / s, there was significant difference between the two groups (both P0.05, right ventricular diameter before and after treatment). They were 28 鹵4.7)mm and 25 鹵3.6 mm, respectively. There was no significant difference between the two groups (P 0.05). One patient had slight elevation of transaminase and one patient had slight headache and flushed face during the treatment. No patient stopped taking the drug because of adverse reactions. Conclusion: Boshentan can significantly improve the exercise endurance of patients with CTEPH, improve hypoxemia and cardiac function grade, decrease pulmonary hypertension and improve the overall tolerance of patients with right ventricular function. Clinical application is relatively safe. In a word, Bosentan is an effective and safe clinical method in the treatment of CTEPH.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1

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