目的 探討地爾硫 聯(lián)合鹽酸川芎嗪治療慢性阻塞性肺疾?。–OPD）合并肺動(dòng)脈高壓的臨床療效。方法 將2012年12月—2014年2月就診于圍場(chǎng)滿族蒙古族自治縣醫(yī)院的COPD合并肺動(dòng)脈高壓患者90例，隨機(jī)分為地爾硫 組（30例）、川芎嗪組（30例）和聯(lián)合用藥組（30例），3組均給予吸氧、抗感染、解痙、平喘、祛痰等對(duì)癥治療。地爾硫 組在對(duì)癥治療的基礎(chǔ)上口服鹽酸地爾硫 片，1片/次，3次/d。川芎嗪組在對(duì)癥治療基礎(chǔ)上，靜脈滴注鹽酸川芎嗪注射液80 mg加入5%葡萄糖250 mL，2 h內(nèi)滴注完畢，1次/d。聯(lián)合用藥組在對(duì)癥治療基礎(chǔ)上加用鹽酸地爾硫 片和鹽酸川芎嗪注射液，用法用量同以上兩組。3組均持續(xù)治療2周。對(duì)3組患者的臨床療效進(jìn)行評(píng)價(jià)，同時(shí)對(duì)肺動(dòng)脈壓力指標(biāo)進(jìn)行檢測(cè)。結(jié)果 地爾硫 組、川芎嗪組、聯(lián)合用藥組的有效率分別為76.7%、76.7%、90.0%，聯(lián)合用藥組的有效率顯著高于其他兩組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，各組肺動(dòng)脈收縮壓和平均壓均較治療前有所下降，治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后聯(lián)合用藥組較其他兩組降低更加明顯，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。3組患者治療后動(dòng)脈氧分壓（PaO₂）、血氧飽和度（SaO₂）、一秒用力呼氣容積（FEV1）占預(yù)計(jì)值的百分比（FEV₁%Pred）、FEV1/用力肺活量（FVC）均較治療前有所升高，治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05），聯(lián)合用藥組較其他兩組升高更加明顯，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 地爾硫 聯(lián)合川芎嗪治療COPD合并肺動(dòng)脈高壓有較好的臨床療效，改善肺動(dòng)脈壓力相關(guān)指標(biāo)，優(yōu)于兩藥單獨(dú)應(yīng)用。

Objective To investigate the clinical efficacy of diltiazem combined with tetramethylpyrazine in treatment of chronic obstructive pulmonary disease (COPD) with pulmonary hypertension. Methods Patients with COPD with pulmonary hypertension were randomly divided into diltiazem (30 cases), ligustrazine (30 cases), and combined treatment (30 cases) groups. The patients in three groups were given oxygen, anti-infection, spasmolysis, smooth wheezing, expectorant, and other symptomatic treatment. Patients in the diltiazem group were po administered with Diltiazem Hydrochloride Tablet on the basis of symptomatic treatment, 1 piece/time, 3 times daily. Patients in the ligustrazine group were iv administered with Tetramethylpyrazine Injection on the basis of symptomatic treatment, 80 mg adding in 5% glucose 250 mL, dripped within 2 h, once daily. Patients in the combined treatment group were given Diltiazem Hydrochloride Tablet and Tetramethylpyrazine Injection, and the usage and dosage were the same with the above two groups. Three groups were continuously treated for 2 weeks. After treatment, the treatment efficacy was evaluated, while the pulmonary artery pressure indexes were tested.Results The efficacies on the patients in the diltiazem, ligustrazine and combined treatment group were 76.7%, 76.7%, and 90.0%, and the clinical efficacies in combined treatment group were higher than those in the other two groups with the significant difference (P< 0.05). After treatment, the pulmonary artery systolic pressure and mean pressure in three groups were declined, and the differences were statistically significant before and after treatment (P< 0.05). Combined treatment group reduced more obviously compared with other two groups, and the difference was statistically significant (P< 0.05). PaO₂, SaO₂, FEV1%Pred, and FEV₁/FVC in three groups were increased, and the differences were statistically significant before and after treatment (P< 0.05). Combined treatment group increased more obviously compared with other two groups, and the difference was statistically significant (P< 0.05). Conclusion Diltiazem combined with tetramethylpyrazine has a good clinical efficacy in the treatment of COPD with pulmonary hypertension, and can improve the pulmonary artery pressure indexes, which is better than that of two drug used alone.

陸成會(huì)，工作于圍場(chǎng)滿族蒙古族自治縣醫(yī)院消化內(nèi)科。