摘要
目的 :探讨重组人脑利钠肽(rhBNP)对急性心肌梗死伴心力衰竭(AMI-HF)患者的疗效以及安全性。方法:选择经皮冠状动脉介入治疗(PCI)后急性心肌梗死合并失代偿性心力衰竭(KillipⅡ~Ⅲ级)患者45例,按随机数字表法分为观察组23例和对照组22例。两组在抗缺血治疗和利尿剂应用的基础上,观察组给予rhBNP治疗,首次负荷剂量为1.5μg/kg,在90 s内静推完毕,在血压>90/60 mm Hg的情况下以0.007 5~0.01μg/(kg·min)连续静滴3 d。对照组给予硝普钠治疗,起始以0.3μg/(kg·min)的速度静滴2 d,再用3μg/(kg·min)速度静滴1 d,维持血压>90/60 mm Hg。在治疗后72 h分别检测两组血N-末端脑钠肽前体(NT-Pro BNP)水平、左室射血分数(LVEF)、左室舒张末内径(LVEDd)变化以及呼吸困难缓解情况,同时记录用药后72 h患者的平均心率、血压、尿量变化。结果 :在用药过程中,观察组1例患者呼吸困难无明显改善,对照组1例死亡,2例症状无改善。治疗后两组心率较治疗前均降低,且观察组低于对照组(P<0.05);治疗后两组血压较治疗前降低不显著,两组比较差异无统计学意义(P>0.05);在整个治疗过程中观察组较对照组尿量增多明显,两组比较差异具有统计学意义(P<0.05)。治疗后两组LVEDd均无明显变化,两组比较差异无统计学意义(P>0.05);两组治疗后LVEF均升高,且观察组高于对照组,差异具有统计学意义(P<0.05);两组治疗后血浆NT-Pro BNP水平均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。两组治疗后呼吸困难评分较治疗前均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。两组不良反应比较,无统计学差异(P>0.05)。结论 :rhBNP可以显著改善AMI-HF患者的心功能以及临床症状,值得推广。
Objective:To investigate the efficacy and safety of recombinant human brain natriuretic peptide(rhBNP) in patients with acute myocardial infarction complicated with heart failure(AMI-HF). Methods:45 patients with acute myocardial infarction complicated with decompensated heart failure(Killip Ⅱ~Ⅲ) after percutaneous coronary intervention(PCI) were randomly divided into observation group(n=23) and control group(n=22). On the basis of anti-ischemic treatment and diuretics use, the patients in the observation group were treated with rhBNP, wherein the first loading dose was 1.5 g/kg, and it was completed within 90 s; under the condition of blood pressure >90/60 mm Hg, continuous intravenous drip at 0.0075~0.01 g/(kg·min) was given for 3 d. The patients in the control group were given sodium nitroprusside, wherein intravenous drip at 0.3 μg/(kg·min) first for 2 d and then at 3 μg/(kg·min) for 1 d was given and blood pressure was maintained at >90/60 mm Hg. The levels of NT-Pro BNP, left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVEDd) and dyspnea demission in the two groups were detected respectively at 72 h after treatment, and at the same time, mean heart rate, blood pressure and urine volume were recorded at 72 h after medication. Results:During drug use, one patient had no significant improvement in dyspnea in the observation group, one patient died and two patients had no improvement in symptoms in the control group. The heart rate in the two groups after treatment was lowered, and the heart rate in the observation group was significantly lower than that in the control group(P<0.05). The blood pressure in the two groups after treatment was not significantly lower than that before treatment, and there was no significant difference between the two groups(P>0.05). During the whole treatment course, the urine volume in the observation group was higher than that in the control group, and the difference between the two groups was statistically significant(P<0.05). The LVEDd was no significant change in two group after treatment, and there was no significant difference between the two groups(P>0.05). The LVEF levels in the two groups were increased after treatment, and the level in the observation group was significantly higher than that in the control group(P<0.05). The average levels of NT-Pro BNP in the two groups after treatment were lower than those before treatment, and the level in the observation group was significantly lower than that in the control group.(P<0.05). The scores of dyspnea in the two groups after treatment were lower than those before treatment, and the score in the observation group was significantly lower than that in the control group(P<0.05). There was no significant difference in adverse reactions between the two groups(P>0.05). Conclusion:rhBNP can significantly improve cardiac function and clinical symptoms of AMI-HF patients, and is worthy promoting.
出处
《中国执业药师》
CAS
2018年第5期55-58,共4页
China Licensed Pharmacist
