151
THE STATE OF CENTRAL HEMODYNAMICS AND ENDOTHELIAL FUNCTION OF
PERIPHERAL VESSELS IN PATIENTS WITH PULMONARY HYPERTENSION
Normatova K., 2nd year master’s, cardiology
Supervisor: Rakhimova D.A., Doctor of Medical Sciences, Republican Specialized
Scientific and Practical Medical Center for Therapy and Medical Rehabilitation, Tashkent
“Faculty internal diseases, military field therapy, occupational pathology, hospital internal
diseases and propaedeutics of internal diseases” Department
Relevance.
Chronic obstructive pulmonary disease (COPD) and severe bronchial asthma (BA) are
some of the main causes of pulmonary arterial hypertension and account for more than 50% in the structure
of pulmonary hypertension formation. The paper studies the state of central hemodynamics and endothelial
function of peripheral vessels in patients with chronic obstructive pulmonary disease, bronchial asthma
complicated by pulmonary hypertension (LH).
Purpose.
Assessment of central hemodynamics and endothelium-dependent vasodilation, as well
as determining the effectiveness of complex therapy.
Materials and methods.
26 patients with COPD (group 1) and 21 patients with BA (group 2)
complicated by pulmonary heart formation were examined. In all patients pulmonary hypertension was
determined (pulmonary arterial pressure avg.> 25 mmHg). For 10 days, patients received nebivolol tablets
at a dose of 5-10 mg per day as part of standard therapy (GOLD, GINA, 2011) and ozone therapy (in the
form of intravenous administration of ozonized physiological solution (1000 mcg / l). A doppler
echocardiographic study of the heart of patients was carried out according to the method of Hatle L.,
Angelsen B. By the spectrophotometric method using the Griss reaction, the functional state of the
endothelium was evaluated, the level of stable metabolites of nitric oxide (SmNO) - nitrites and nitrates in
blood plasma was studied.
Results
. Prior to treatment, a significant violation of endothelial function was revealed, which
manifests itself in an increased overall synthesis of SmNO. In patients of the 2nd group, compared with the
1st group, such hyperproduction is less by 14%. When determining the parameters of central
hemodynamics, signs of a deterioration in the diastolic function of the right ventricle and a decrease in the
ratio of early and late filling were recorded. Also, an increase in mean pressure in the pulmonary artery was
detected in all patients with CPC, significantly higher in patients of the 1st group. When using nebivolol
against the background of standard therapy and ozone therapy, we noted the following features: in the
conditions of initial overproduction of nitric oxide, there is a limitation of the synthesis of SmNO in blood
plasma in groups 1 and 2 by 1.05 and 1.5 times, respectively(p <0.05). With repeated doppler
echocardiography, a decrease in the degree of systolic pressure in the pulmonary artery is observed in both,
the 1st group by 7.3% and the 2nd group by 8.8% and the ratio of early and late filling of the right ventricle
of the heart increases by 1.07 and 1.08 times (p <0.05). A tendency to improve the parameters of systolic
and diastolic function of the right ventricle in both groups was also identified. Thus, the atrial filling fraction
and isovolumic relaxation time decreased respectively by 11.2 and 4.1% in the 1st group, by 22 and 9.3%
in the 2nd group.
Findings.
In patients with BA complicated pulmonary heart disease with pulmonary hypertension,
overproduction of stable NO metabolites is moderate compared to in patients with COPD complicated by
pulmonary heart disease with pulmonary hypertension. Nebivolol corrects SmNO values in blood plasma,
respectively, improves endothelial function of blood vessels and indicators of central and peripheral
hemodynamics.
References:
1.
Алиев
,
Махмутжон Муслимович
, et al. "
Диагностика и хирургическое лечение гипоплазии легких
у детей
."
Детская хирургия
2 (2011): 34-38.
