参附联合重组人脑利钠肽治疗急性心肌梗死并泵衰竭的疗效评价  

Therapeutic effects of recombinant human brain natriuretic peptide combined with ShenFu for the treatment of acute myocardial infarction complicated with heart failure

作　　者：赵进[1] 李彪[1] 赵强[1] 吴同果[1] 

机构地区：[1]暨南大学医学院附属第四医院广州市红十字会医院心内科,广州

出　　处：《国际医药卫生导报》2011年第1期4-10,共7页International Medicine and Health Guidance News

基　　金：2007年广州市卫生局中医处课题（2007B23）

摘　　要：目的 评价重组人脑利钠肽（rhBNP）和参附注射液联合治疗急性心肌梗死（AMI）伴急性心力衰竭（AHF）患者的有效性和安全性.方法 将符合AMI伴AHF诊断标准并排除心源性休克的患者随机分为rhBNP治疗组和rhBNP联合参附注射液治疗组,每组各31例患者.比较两组治疗前后血压、心率、尿量、呼吸困难程度、神经内分泌激素水平和超声心动图指标的变化及临床终点事件、不良反应发生率.结果 （1）与rhBNP组相比,rhBNP联合参附注射液治疗组血压下降的程度不显著（P＜0.05）;治疗期间每24 h的尿量均显著增多（P＜0.001）;明显改善呼吸困难（P＜0.001）;神经内分泌激素的水平明显下降（P＜0.01）.（2）用药后6个月,联合治疗组LVEF明显升高[（42.2±3.70）%vs（35.8±4.56）%,P＜0.01];LVEDD有轻度减小[（53.2±3.2）mm vs（57.8±3.8）mm,P=0.026];总的临床终点事件的发生率有降低趋势（2 vs 6,P=0.108）.（3）与rhBNP组相比,rhBNP联合参附注射液治疗组低血压的发生率较低（1 vs 8,P＜0.05）;在保证SBP 130～90 mmHg及DBP 80～60 mmHg的情况下,两组患者均没有出现肾功能不全或原有肾功能不全加重.结论 （1）rhBNP能有效抑制AMI伴AHF患者的神经内分泌激素的激活,改善血流动力学;rhBNP联合参附注射液治疗更有利于改善呼吸困难的程度,控制心衰,更有助于左室收缩功能的恢复,能降低AMI并AHF患者总的临床终点事件的发生率.（2）参附联合rhBNP治疗AMI伴AHF更安全有效.Objective To evaluate the efficacy and safety of intravenous infusion recombinant human brain natriuretic peptide （rhBNP） combined with ShenFu in treating patients with acute myocardial infarction （AMI） complicated with acute heart failure （AHF）Methods 62 patients with AMI complicated with AHF were randomly divided into rhBNP group and combined with ShenFu and rhBNP treatment group.Patients with cardiac shock or severe hypotension were excluded from the study. Blood pressre, heart rate, 24 hours urine output, dyspnea grade, plasma concentration of neuroendocrine hormone, ultrasonic cardiography （UCG） parameters were evaluated before and after drug infusion. Major adverse cardiovascular events （MACE） and adverse drug reactions were also analyzed. Results ① Compared with rhBNP group,combination treatment group showed a more increase of 24 hours urine output （P〈0.001） .A less decrease of blood pressure was seen in combination treatment group （P〈 0.05）. Dyspnea improvement （P〈 0.001）and plasma concentration of neuroendocrine hormone decrease （P〈0.01） were more significant in combination treatment group compared to rhBNP group. ②The left ventricular ejection fraction （LVEF） increasing in combination treatment group was higher than that in rhBNP group following 6 months drug therapy[ （42.2 ±3.70 ） % vs （ 35.8 ± 4.56 ） % P〈 0.01）], and the left ventricular end-diastolic dimension （LVEDD）decreasing was seen only in combination treatment group[（53.2 ± 3.2mm vs 57.8 ± 3.8mm P=0.026）]. The 6-month composite MACE rate tended to decrease in combination treatment group compared to rhBNP group （2 vs 6, P=0.108）.③Compared with rhBNP group, the incidence of hypotension was lower in Combination treatment group.（1 vs 8, P〈0.05）.Conclusion ①Combination treatment is superior to single rhBNP in inhibiting the activation of neuroendocrine hormone, improving hemodynamics and dyspnea and cardiac systolic fuction. rhBNP combined with ShenFu can decre

关 键 词：重组人脑利钠肽 参附 急性心肌梗死 泵衰竭 

分 类 号：R541[医药卫生—心血管疾病] R542[医药卫生—内科学]