Pogorelov V.N., Maslova E.P., Mieshchanina D.R.

Kharkiv National Medical University

Department of Interior and Occupational Diseases

Kharkov, Ukraine

FEATURES OF TREATMENT OF PATIENTS WITH CHRONIC PULMONARY HEART

Relevance. The prevalence of clinically significant manifestations of chronic pulmonary heart (CPH) is 2-6 cases per 1000 people. Each year new cases of CPH - 1-3 per 10 000 people. COPD is characterized by progressive airflow obstruction, and exacerbation of the pathological process leads to changes in the normal diurnal variation of symptoms with an increase in the average pulmonary artery pressure (PASP), which is a consequence of chronic pulmonary heart. In patients with COPD develop CPH is a poor prognosis factor.

Objective: improvement of methods of treatment of patients with CPH .

Materials and methods. In the therapeutic department of Road Clinical Hospital Art. Kharkiv in the 2014-2016 biennium. The study included 59 patients with blood circulation (NC) IIA - B on the background of CPH. The average age of patients was 66 ± 5 years. Patients were divided into two groups. Both groups were compared on the condition, age, clinical and functional form of the disease. There was clinical and laboratory identity of patients. All patients received combined therapy.

Status of intracardiac hemodynamics was assessed by echocardiography, mean pulmonary artery pressure (PASP) - via dopplerEhoKG.

Status of blood gas composition was evaluated in terms of PCO2 and PO2 in arterial blood. The level of endothelin - 1, renin, angiotensin, aldosterone, and cyclic nucleotides and cytokines were measured by ELISA .

Patients of group 1 ( 20 ) further comprises telmisartan 80 mg / day ( control group). Patients of the second group ( 39 people ) - telmisartan + torasemid® 20 mg / day ( study group).

The results of research. Against the background of the therapy in patients with 2nd observation group, compared to patients with the 1st group , there was a significant improvement in overall condition . On palpation determined the decrease in liver size and practically disappeared lower limb edema, accompanied by improvements in exercise tolerance.

After treatment with torasemide and telmisartan noted a significant decrease in PASP, heart rate and an increase in ejection fraction. Positive changes of hemodynamic parameters suggest that these drugs block the pressor system of patients with CPH and cause tissue relaxation and vasodilation.

Changes in RAAS and the content of sodium and potassium ions in the blood serum during therapy with telmisartan alone and in combination with torasemidom® show that their effects, these drugs are realized through the RAAS. This confirms the reduction of angiotensin II and aldosterone in the 2nd group of observations. Reducing the level of aldosterone in the 2nd group of observations suggest that the combination of these medicinal products fully meet the need for their inclusion in the treatment of patients with NK CCP.

Conclusions. 1.Application telmisartana combined with torasemidom® in the treatment of patients with CPH accompanied by an improvement of intracardiac hemodynamics and reduced clinical manifestations of circulatory failure .

2. Positive changes in the indices of the RAAS , endothelin - 1 under the influence of this combination of products create conditions for restoring the function of vascular endothelium as well as the geometry of the heart in patients with CPH .

3. Treatment of circulatory failure in patients telmisartan CCP and its combination with torasemidom® clinically accompanied by signs of violation of the ion exchange of sodium and potassium , which gives grounds for wider use of this combination in the treatment of patients with CPH .