Analysis Of Therapeutic Effect Of Alprostadil In The Treatment Of Chronic Pulmonary Heart Disease

Objective: To observe Alprostadil's therapeutic efficacy of Pulmonary Artery Hypertension in Chronic Pulmonary Heart Disease with COPD patients and Alprostadil's influence on the blood coagulation system, and the safety of combined use of Alprostadil and Low Molecular Weight Heparin.Methods: Retrospective analysis 80 patients which were diagnosed for AECOPD with AECPHD hospitalized at the Respiratory Medicine of Yanan University Affiliated Hospital from November 2014 to December 2015.According of whether used alprostadil,the patients were divided into two groups :1.the control group, according to the condition,the group was given conventional treatment, such as correction of hypoxia, anti infection, antispasmodic, diuretic,expanding blood,correct electrolyte and acid-base balance disorders, nutritional support, hormone and low molecular weight heparin; 2. the observation group,it was plus given alprostadil on the basis of conventional treatment.To observe the changes of PLT,APTT, PT, D-D, Fg, Pa CO₂, Pa O₂, SO₂, PASP, brachial artery systolic blood pressure and diastolic blood pressure between the two groups before and after treatment. The symptoms and signs of the patients were observed during the period of using drug, and the adverse reactions were recorded. Result:1. Comparison of blood gas analysis. Before treatment, Pa O₂ and SO₂ of the two groups were lower than the normal range, the Pa CO₂ was higher than the normal range, compared Pa O₂, Pa CO₂ and SO₂ in the two groups before treatment, P was >0.05, with comparability. After treatment, Pa O₂, SO₂ and Pa CO₂ of the two groups were improved than before treatment?P<0.05?,which showed that the difference between before and after treatment in the two groups was statistically significant. But comparing these three indicators after treatment in the two groups, the difference was not statistically significant?P>0.05?.2. Comparison of platelet. The platelet of two groups after treatment were lower than before treatment, and the difference between before and after treatment were statistically significant?P < 0.05?. Before treatment, the two groups were comparable. Comparing the platelet after treatment, the difference of the two groups was statistically significant?P < 0.05?.3. Comparison of coagulation parameters. PT and APTT in the two group which were shortened before treatment were extend after treatment. The difference between before and after treatment in the two groups was statistically significant?P < 0.05?. Comparing PT and APTT after treatment, the difference of the two groups was statistically significant?P < 0.05?, which showed that the observation group can make PT and APTT extended more. Fg and D-D before treatment in the two groups were increased, after treatment them were lower than before. The difference between before and after treatment in the two groups was statistically significant?P < 0.05?. Comparing D-D and Fg after treatment, the difference of the two groups was statistically significant?P < 0.05?,which showed that the observation group can make D-D and Fg decreased significantly.4. Comparison of the Pulmonary Artery Systolic Pressure?PASP?. There were pulmonary arterial hypertension in the two groups before treatment. The difference between before and after treatment in the control group was not statistically significant?P > 0.05?.But the difference between before and after treatment in the observation group was statistically significant?P < 0.05?,and PASP after treatment was significantly lower than before treatment.5. Comparison of systolic blood pressure and diastolic blood pressure of right upper limb before and after treatment in observation group. The difference of the systolic blood pressure between before and after treatment was not statistically significant?P > 0.05?, and the difference of the diastolic blood pressure was also not statistically significant?P > 0.05?.6. Evaluating the efficacy and safety. No one died during the study period, patients with complete data acquisition. After one week's treatment, two groups of patients have different degrees of improvement in symptoms, signs, auxiliary examination results, and there was no case of serious heart failure. Before treatment, 5 cases in the control group and 3 cases in the observation group were found to have venous thrombosis of lower limb, and there was no pulmonary embolism. Three patients in observation group had pain and discomfort at the injection site, they could tolerate. Slowing intravenous speed can release the pain and discomfort which did not affect the treatment process. Hemoptysis, nose, skin and mucous membrane or other locus had not appeared bleeding in the two groups of patients. Conclusion:1.Alprostadil can significantly reduce pulmonary artery systolic pressure in patients with chronic pulmonary heart disease,with less impact on the body circulation pressure.2. AECOPD with AECPHD patients have complicated blood state, such as blood hypercoagulability, thrombosis and secondary hyperfibrinolysis state. Conventional therapy which includes low molecular weight heparin can improve this state on a certain degree, and with Alprostadil can more significantly improve the state.3.Alprostadil have few adverse reaction and higer safety. The application of Alprostadil combined with LMWH is safe.