目的 探讨地尔硫 联合盐酸川芎嗪治疗慢性阻塞性肺疾病（COPD）合并肺动脉高压的临床疗效。方法 将2012年12月—2014年2月就诊于围场满族蒙古族自治县医院的COPD合并肺动脉高压患者90例，随机分为地尔硫 组（30例）、川芎嗪组（30例）和联合用药组（30例），3组均给予吸氧、抗感染、解痉、平喘、祛痰等对症治疗。地尔硫 组在对症治疗的基础上口服盐酸地尔硫 片，1片/次，3次/d。川芎嗪组在对症治疗基础上，静脉滴注盐酸川芎嗪注射液80 mg加入5%葡萄糖250 mL，2 h内滴注完毕，1次/d。联合用药组在对症治疗基础上加用盐酸地尔硫 片和盐酸川芎嗪注射液，用法用量同以上两组。3组均持续治疗2周。对3组患者的临床疗效进行评价，同时对肺动脉压力指标进行检测。结果 地尔硫 组、川芎嗪组、联合用药组的有效率分别为76.7%、76.7%、90.0%，联合用药组的有效率显著高于其他两组，差异均有统计学意义（P<0.05）。治疗后，各组肺动脉收缩压和平均压均较治疗前有所下降，治疗前后差异有统计学意义（P<0.05）；治疗后联合用药组较其他两组降低更加明显，差异有统计学意义（P<0.05）。3组患者治疗后动脉氧分压（PaO₂）、血氧饱和度（SaO₂）、一秒用力呼气容积（FEV1）占预计值的百分比（FEV₁%Pred）、FEV1/用力肺活量（FVC）均较治疗前有所升高，治疗前后差异有统计学意义（P<0.05），联合用药组较其他两组升高更加明显，差异有统计学意义（P<0.05）。结论 地尔硫 联合川芎嗪治疗COPD合并肺动脉高压有较好的临床疗效，改善肺动脉压力相关指标，优于两药单独应用。

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.

陆成会，工作于围场满族蒙古族自治县医院消化内科。