目的 探討比索洛爾與卡維地洛對心力衰竭合并慢性阻塞性肺疾?。–OPD）患者心肺功能及血清學(xué)指標(biāo)的影響。方法 選取2017年3月—2019年3月河南科技大學(xué)附屬許昌市中心醫(yī)院82例心力衰竭合并COPD患者作為研究對象，根據(jù)隨機(jī)抽簽原則將患者分為對照組（41例）和觀察組（41例）。對照組患者在常規(guī)治療的基礎(chǔ)上口服卡維地洛片，初始劑量為2.5 mg/次，之后根據(jù)患者具體病情及耐受性可逐漸增加，體質(zhì)量在85 kg以內(nèi)者最大劑量為20 mg/次，2次/d；體質(zhì)量在85 kg以上者最大劑量為50 mg，2次/d。觀察組患者在常規(guī)治療的基礎(chǔ)上口服富馬酸比索洛爾片，初始劑量為1.25 mg/次，1次/d，連續(xù)服用7 d后可增加至2.5 mg/次，1次/d；之后在依次增加至5 mg/次，1次/d，1個(gè)月增加至7.5 mg/次，1次/d，再持續(xù)治療1個(gè)月后根據(jù)患者的耐受情況增加至10 mg/次，1次/d。兩組均連續(xù)治療3個(gè)月。觀察兩組患者治療前后的心肺功能指標(biāo)、血清學(xué)指標(biāo)和不良反應(yīng)發(fā)生情況。結(jié)果 治療后，兩組患者左心射血分?jǐn)?shù)（LVEF）和6 min步行距離（6 MWD）均顯著升高，左室收縮末期內(nèi)徑（LVESD）、左室舒張末期內(nèi)徑（LVEDD）明顯降低（P<0.05）；且觀察組治療后各心功能指標(biāo)顯著優(yōu)于對照組（P<0.05）。治療后，兩組患者第1 s用力呼氣量（FEV₁）、用力肺活量（FVC）、呼氣峰流速（PEF）、最大呼氣中期流速（MMEF）和FEV₁/FVC水平均明顯升高（P<0.05）；且觀察組各肺功能指標(biāo)顯著高于對照組（P<0.05）。治療后兩組患者白細(xì)胞介素-6（IL-6）C反應(yīng)蛋白（CRP）、內(nèi)脂素、腦鈉肽（BNP）及N末端B型利鈉肽原（NT-proBNP）水平均明顯降低（P<0.05）；且觀察組血清學(xué)指標(biāo)水平顯著低于對照組（P<0.05）。治療期間，觀察組患者不良反應(yīng)發(fā)生率顯著低于對照組，兩組比較存在統(tǒng)計(jì)學(xué)差異（P<0.05）。結(jié)論 與卡維地洛相比，比索洛爾更有利于抑制機(jī)體炎性反應(yīng)，改善其心肺功能，且不良反應(yīng)少，對控制心力衰竭合并COPD病情進(jìn)展，對促進(jìn)病情康復(fù)具有積極意義。

Objective To investigate the effect of bisoprolol and carvedilol on cardiopulmonary function and serologic indexes in patients with heart failure complicated with COPD. Methods A total of 82 patients with heart failure complicated with COPD in Xuchang Central Hospital Affiliated to Henan University of Science and Technology from March 2017 to March 2019 were selected as study subjects, and the patients were divided into control group (41 cases) and observation group (41 cases) according to the principle of random lottery. Patients in the control group po administered with Carvedilol Tablets on the basis of conventional treatment, the initial dose was 2.5 mg/time, then gradually increased according to the patient's specific condition and tolerance. The maximum dose of weight less than 85 kg was 20 mg/time and twice daily, the maximum dose of 85 kg or more was 50 mg/time, twice daily. Patients in the observation group were po administered with Bisoprolol Fumarate Tablets on the basis of conventional treatment, the initial dose was 1.25 mg/time, once daily, which could be increased to 2.5 mg/time, once daily after continuous 7 days. After that, it was successively increased to 5 mg/time, once daily. Then 7.5 mg/time, once daily for 1 month, and increased to 10 mg/time, once daily according to the patient's tolerance after 1 month of continuous treatment. Both groups were treated continuously for 3 months. After treatment, the cardiopulmonary function, serological index, and adverse reactions in two groups before and after treatment were observed. Results After treatment, LVEF and 6 MWD were significantly increased in two groups, while LVESD and LVEDD were decreased (P<0.05). And the cardiac function indexes in the observation group were significantly better than those in the control group (P<0.05). After treatment, FEV₁, FVC, PEF, MMEF, and FEV₁/FVC levels were significantly increased in two groups (P<0.05). And the lung function indexes in the observation group were significantly higher than those in the control group (P<0.05). After treatment, the levels of IL-6, CRP, endoliptin, BNP, and NT-proBNP in two groups were significantly decreased (P<0.05). And the serological indexes level in the observation group were significantly lower than those in the control group (P<0.05). During treatment, the incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). Conclusion Compared with carvedilol, bisoprolol is more conducive to inhibiting the body's inflammatory response and improving its cardiopulmonary function, with fewer adverse reactions, which is of positive significance for controlling the progression of heart failure complicated with COPD, and promoting the rehabilitation of the disease.

R972;R974

河南省科技發(fā)展計(jì)劃項(xiàng)目（182102310214）；許昌市重大科技專項(xiàng)（20180113031）