摘要
目的:分析不同剂量重组人脑利钠肽(rhBNP)治疗急性失代偿性心力衰竭(ADHF)合并肾功能不全的临床价值。方法:选择2018年12月至2020年1月浙江省嘉兴市第二医院收治的ADHF合并肾功能不全患者80例,按随机数字表法分为A、B组,每组40例,两组均予常规抗心力衰竭配合rhBNP治疗,A、B两组rhBNP负荷剂量均为0.1μg/kg,A组负荷剂量后予rhBNP 0.01μg/(kg·min)持续给药24 h,B组予0.015μg/(kg·min)rhBNP持续给药24 h,比较两组治疗效果,监测用药前后患者收缩压、舒张压、呼吸频率、心率及呼吸困难程度的变化,测定两组患者血肌酐、胱抑素C、左室射血分数(LVEF)、左室舒张末期内径、N-末端B型利钠肽前体(NT-proBNP)等心肾功能指标的变化,统计24 h尿量的变化,计算估计肾小球滤过率,观察不良反应发生情况及近4周内主要心血管不良事件发生率。结果:A、B组疗效分级比较差异无统计学意义(P>0.05);用药24 h,B组HR、呼吸困难评分低于A组[(83.86±4.75)次/min比(86.52±5.77)次/min、(1.52±0.43)分比(1.89±0.34)分](P<0.05);用药结束,B组LVEF高于A组[(47.52±5.41)%比(43.75±4.53)%],NT-proBNP低于A组[(3652.41±462.56)ng/L比(3986.57±314.21)ng/L](P<0.05);用药结束,两组Scr降低,24 h尿量上升,但组间比较差异无统计学意义(P>0.05);A、B组不良反应发生率及不良心血管事件发生率比较差异无统计学意义(P>0.05)。结论:0.015μg/(kg·min)rhBNP维持治疗ADHF合并肾功能不全对患者心功能改善价值优于0.01μg/(kg·min)维持剂量,不会加重患者肾功能受损,安全可行。
Objective To analyze the clinical value of different doses of recombinant human brain natriuretic peptide(rhBNP)in the treatment of acute decompensated heart failure(ADHF)combined with renal insufficiency.Methods Eighty patients with ADHF combined with renal insufficiency admitted to Jiaxing Second Hospital from December 2018 to January 2020 were selected.According to the random number table method,they were divided into A,B group,with 40 cases in each group.Two groups were treated with the conventional anti heart failure combined with rhBNP.The rhBNP loading doses of A and B group were 0.1μg/kg.Group A was continually given rhBNP 0.01μg/(kg·min)for 24 h after the loading dose,while group B was continually given 0.015μg/(kg·min)rhBNP for 24 h.The efficacy of the two groups was compared,changes of systolic blood pressure(SBP),diastolic blood pressure(DBP),respiratory frequency(RR),heart rate(HR)and the degree of dyspnea of patients before and after the medication were monitored,and changes of serum creatinine(Scr),Cystatin C(Cys-C),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),N-terminal pro B-type natriuretic peptide(NT-proBNP)and other cardiorenal function indexes of patients were determined.The changes of 24 h urine output were calculated,estimated glomerular filtration rate(eGFR)was counted,and the occurrence of adverse reactions and the incidence of major cardiovascular adverse events in the last 4 weeks in the two groups were observed.Results There was no significant difference in the efficacy classification between group A and group B(P>0.05).After 24 h of administration,the scores of HR and dyspnea in group B were lower than those in group A[(83.86±4.75)times/min vs.(86.52±5.77)times/min,(1.52±0.43)points vs.(1.89±0.34)points](P<0.05).At the end of the treatment,the level of LVEF in group B was higher than that in group A[(47.52±5.41)%vs.(43.75±4.53)%],and the level of NT-proBNP was lower than that in group A[(3652.41±462.56)ng/L vs.(3986.57±314.21)ng/L](P<0.05).At the end of the treatment,the level of Scr of the two groups decreased and 24 h urine output increased,but there was no statistically significant difference between the two groups(P>0.05).There was no statistically significant difference in the incidence of adverse reactions and adverse cardiovascular events between groups A and B(P>0.05).Conclusions 0.015μg/(kg·min)rhBNP maintenance therapy is more effective in improving cardiac function compared with that of 0.01μg/(kg·min)maintenance doses in the treatment of ADHF combined with renal insufficiency,and it is safe and feasible without aggravating renal impairment of patients.
作者
徐烨
王海峰
Xu Ye;Wang Haifeng(Department of Emergency,Jiaxing Second Hospital,Zhejiang Jiaxing 314000,China)
出处
《中国医师进修杂志》
2020年第12期1114-1119,共6页
Chinese Journal of Postgraduates of Medicine
关键词
利钠肽
脑
重组
剂量效应关系
药物
急性失代偿性心力衰竭
肾机能不全
Natriuretic peptide,brain,recombinant
Dose-response relationship,drug
Acute decompensated heart failure
Renal insufficiency
