波生坦治疗慢性血栓栓塞性肺动脉高压的临床观察

发布时间：2018-05-19 15:45

本文选题：慢性血栓栓塞性肺动脉高压 + 疗效观察　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:本文通过分析16例应用波生坦治疗的慢性血栓栓塞性肺动脉高压(CTEPH)患者的临床资料,总结波生坦治疗CTEPH的有效性和安全性。方法:采用回顾性研究方法进行研究。研究对象为2014年1月至2016年8月就诊于山西医科大学第一医院呼吸内科接受波生坦治疗的CTEPH患者,将16例符合入选标准、无排除标准的CTEPH患者纳入研究。收集入选患者波生坦治疗前与治疗6月后的临床资料并分为两组,比较治疗前后两组观察指标的变化情况,总结波生坦治疗CTEPH的临床疗效和安全性。疗效评估指标包括:6分钟步行距离(6MWD)、Borg呼吸困难指数评分、WHO心功能分级及NT-proBNP,动脉血气分析指标:PaO2和PaCO2,超声心动图指标:肺动脉收缩压(PASP)、三尖瓣反流速度(TRV)、右心室前后径、心包积液发生率;安全性评估指标包括:肝功能和血细胞分析,同时记录头痛、面部潮红、胃肠道反应等其他不良反应。结果:治疗后CTEPH患者的运动耐力和呼吸困难明显改善,6MWD由治疗前(324.8±116.4)m增加至(357.3±104.6)m;Borg呼吸困难指数评分由治疗前(3.27±1.19)降至(2.14±0.73),两组比较差异均有统计学意义(均P0.05)。治疗后患者WHO心功能分级较治疗前显著降低,两组比较差异有统计学意义(P0.05)。NT-proBNP水平由治疗前(1869.79±793.62)pg/ml降低至(836.21±294.32)pg/ml,两组比较差异有统计学意义(P0.05)。动脉血气分析结果显示:PaO22由治疗前(53±3.7)mmHg升高至(78±6.3)mmHg,两组比较差异具有统计学意义(P0.05);PaCO2治疗前后分别为(37±6.4)mmHg和(41±2.3)mmHg,两组比较差异无统计学意义(P0.05)。超声心动图结果提示:PASP由治疗前(80.1±26.3)mmHg降低至(63.4±22.7)mmHg,TRV由治疗前(4.5±0.69)cm/s降低至(3.7±0.87)cm/s,心包积液发生率由治疗前43.75%下降至18.75%,两组比较差异均有统计学意义(均P0.05);治疗前后右心室前后径分别为(28±4.7)mm和(25±3.6)mm,两组比较差异无统计学意义(P0.05)。治疗期间1例患者出现转氨酶轻度升高,1例患者出现轻微头痛、面部潮红,无患者因不良反应停止用药。结论:波生坦可明显提高CTEPH患者的运动耐力,显著改善患者低氧血症及心功能分级,并有效降低患者肺动脉高压和改善右心室功能状态。CTEPH患者对波生坦治疗的整体耐受性良好,临床应用较为安全。总之,波生坦是治疗CTEPH的一种有效且安全的临床手段。
[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 卤116.4mm to 357.3 卤104.6mBorg dyspnea index from 3.27 卤1.19 to 2.14 卤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 卤793.62)pg/ml to 836.21 卤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 卤3.7)mmHg to 78 卤6.3mm Hg.The difference between the two groups was statistically significant (P 0.05): P0.05 卤Pao 2 was 37 卤6.4)mmHg and 41 卤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 卤26.3)mmHg to 63.4 卤22.7mm before treatment from 4.5 卤0.69)cm/s to 3.7 卤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 卤4.7)mm and 25 卤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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

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