CAJ | 학술논문

目的：对比肾素-血管紧张素-醛固酮系统( RAS )抑制剂与血管紧张素受体阻滞剂( ARBS)在重度COPD合并慢性肺源性心脏病患者中的临床疗效。方法：选取自2011年12月至2012年12月收治的重度COPD合并慢性肺源性心脏病患者120例，将其作为临床研究对象，随机分为对照组和观察组，每组60例。两组患者在控制感染、平喘、强心、氧疗等基础上，对照组患者采取( RAS)抑制剂ACEI进行治疗，观察组患者采取ARBS进行治疗。观察并比较两组患者的治疗效果。结果：治疗后两组患者的肺功能各项指标均较高于治疗前，而血压、心率则明显较治疗前有所降低；治疗后两组患者肺功能指标结果较为相近，无明显差异(P>0.05)，观察组患者治疗后血压低于对照组，而心率则明显高于对照组；两组患者治疗后的血浆粘度、纤维蛋白原明显低于治疗前，但血红蛋白、红细胞计数与治疗前比较无明显差异(P>0.05)，两组患者组间比较也无显著差异(P>0.05)；两组患者并发症的发生率一致，均为5.00%。结论：RAS抑制剂和ARBS对COPD合并慢性肺源性心脏病的疗效均较显著，且两者的疗效较为相近，均能明显改善患者的肺功能情况，血液的粘滞度明显降低，明显减轻了心脏的负荷。
목적：대비신소-혈관긴장소-철고동계통( RAS )억제제여혈관긴장소수체조체제( ARBS)재중도COPD합병만성폐원성심장병환자중적림상료효。방법：선취자2011년12월지2012년12월수치적중도COPD합병만성폐원성심장병환자120례，장기작위림상연구대상，수궤분위대조조화관찰조，매조60례。량조환자재공제감염、평천、강심、양료등기출상，대조조환자채취( RAS)억제제ACEI진행치료，관찰조환자채취ARBS진행치료。관찰병비교량조환자적치료효과。결과：치료후량조환자적폐공능각항지표균교고우치료전，이혈압、심솔칙명현교치료전유소강저；치료후량조환자폐공능지표결과교위상근，무명현차이(P>0.05)，관찰조환자치료후혈압저우대조조，이심솔칙명현고우대조조；량조환자치료후적혈장점도、섬유단백원명현저우치료전，단혈홍단백、홍세포계수여치료전비교무명현차이(P>0.05)，량조환자조간비교야무현저차이(P>0.05)；량조환자병발증적발생솔일치，균위5.00%。결론：RAS억제제화ARBS대COPD합병만성폐원성심장병적료효균교현저，차량자적료효교위상근，균능명현개선환자적폐공능정황，혈액적점체도명현강저，명현감경료심장적부하。
Objective:To compare and discuss the clinical effect of RAS inhibitor and APBs in treat-ment of severe COPD accompanied with chronic cor pulmonale. Method:120 patients with severe COPD ac-companied with chronic cor pulmonale received the treatment in our hospital from December 2011 to Decem-ber 2012 were selected as clinical research objects, and they were randomly divided into the control group (60 cases) and the observation group (60 cases). On the basis of the control of infections, asthma, cardiac and oxygen therapy, patients in the control group took ( RAS) inhibitor of ACEI for treatment, while the pa-tients in the observation group took ARBS for treatment. The therapeutic effect for patients in the two groups were observed and compared. Result:Indexes of lung function for patients in the two groups after treatment were higher than that before the treatment, and the blood pressure and heart rate were significantly reduced with that before the treatment;the index results of lung function for patients in the two groups after treatment were relatively close, which had no significant differences ( P>0.05) . The blood pressure for patients in the observation group after treatment was lower than of the control group, while the heart rate was significantly higher than that of the control group; the blood plasma viscosity and fibrinogen content for patients in two groups after treatment were obviously lower than that before the treatment, but the hemoglobin and red blood cell had no significant difference compared with that before the treatment, (P>0.05), and the comparison between the two groups also had no significant difference ( P>0.05);the incidence of complications for pa-tients in the two groups was same, 5.00% both. Conclusion:PAS inhibitor and ABRS both have significant effect in the treatment of COPD accompanied chronic cor pulmonale, and the curative effects are relatively close;they can both significantly improve lung function patients, lower the blood viscosity and reduce the load of the heart.