重组人脑利钠肽治疗风湿性瓣膜病伴心肾综合征患者围术期效果的随机对照试验  

Effectiveness of Preoperative Recombinant Human Brain Natriuretic Peptide on Rheumatic Valves Diseases with Cardiorenal Syndrome:A Randomized Controlled Trial

作　　者：蒋钦[1] 向波[1] 于涛[1] 黄克力[1] 

机构地区：[1]四川省医学科学院四川省人民医院心脏外科中心,成都610072

出　　处：《中国胸心血管外科临床杂志》2016年第8期760-764,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省人民医院博士科研基金(30305030842)~~

摘　　要：目的 探讨术前静脉输入重组人脑利钠肽对风湿性心脏瓣膜病伴心肾综合征患者的作用，比较用药前后心、肾功能及手术相关的指标。方法 采用随机、单盲药物对照研究方法。入选2012年3月至2015年3月四川省人民医院60例左心室射血分数〈40%且肾功能不全的风湿性心脏瓣膜病患者。其中男24例、女36例，年龄35～73（52.1± 8.9）岁。采用随机数字表法将患者分为试验组和对照组。对照组接受静脉输注多巴胺和硝酸甘油为基础抗心力衰竭治疗（n=30），试验组在此基础上给予48 h重组人脑利钠肽（n=30）。结果 与对照组相比，重组人脑利钠肽联合治疗48 h后的NT pro-BNP较基线水平降低 [ （88.6±55.1） pg/ml vs. （55.0±47.6） pg/ml , P=0.014]，高敏C-反应蛋白较基线水平降低[（2.79±1.27） mg/l vs. （1.39±0.79） mg/l，P=0.000 ]，24 h尿量较基线水平增加[ （1 464.0±348.3） ml vs. （1 223.0±279.9） ml，P=0.005]，血胱抑素-C较基线水平降低[ （0.25±0.14） mg/l vs. （0.08±0.07） mg/l，P=0.000]，差异均有统计学意义。术后3 d平均正性肌力药物使用强度降低[ （2.52±1.30） mg·kg-1 ·min-1 vs. （3.36±1.15） mg·kg-1 · min-1，P=0.011]， 术后ICU时间缩短[ （4.5±1.2） d vs. （5.3±1.6） d，P=0.03]，差异均有统计学意义。两组治疗后心功能分级、左心室射血分数、左心室舒张期末直径、血清肌酐及术后胸腔引流量、主动脉内球囊反搏差异无统计学意义（P〉0.05）。结论 术前静脉输注重组脑利钠肽有助于降低心肾综合征患者全身炎症反应及心肾功能损伤，改善术后恢复时间。Objective To investigate the efficacy of intravenous infusion of recombinant human brain natriuretic peptide in rheumatic heart valves patients with cardiorenal syndrome preoperatively, the function and operational results before and after treatment were compared. Methods A randomized, single-blind, and controlled study was conducted in 60 patients characterized of rheumatic heart valves patients in our hospital from March 2012 through March 2015. There were 24 males and 36 females at average age of 52.1± 8.9 years （ranged from 35-73 years）. Their left ventricular ejection fraction was less than 40% and plasma creatinine was mildly or moderately raised. They were recruited into an experiment group and a control group by random digital table. The control group received continuous intravenous Dopamine and Nitroglycerin based anti-heart failure treatment （n=30）. The experimental group received additional recombinant human brain natriuretic peptide for 48 hours without bolus （at a dose of 0.006 μg ？ kg-1 ？ min-1, n=30）. The levels of the biomarkers for cardiac and renal function between before and after treatment were compared. Results In the experiment group, treatment with recombinant human brain natriuretic peptide for 48 hours had lower level of plasma NT-proBNP than the baseline level with a statistical difference （88.6±55.1 pg/ml vs. 55.0±47.6 pg/ml , P=0.014）, lower level of high sensitivity creative reaction protein than the baseline level with a statistical difference （2.79±1.27 mg/l vs. 1.39±0.79 mg/l,P=0.000）, more 24 hours urine output than the baseline level with a statistical difference （1 464.0±348.3 ml vs. 1 223.0±279.9 ml, P=0.005）, lower level of serum cystatin-C than the baseline level with a statistical difference （0.25±0.14 mg/l vs. 0.08±0.07 mg/l, P=0.000）, higher inotrope requirement within three days after operation （2.52±1.30 mg ？ kg-1 ？ min-1 vs. 3.36±1.15 mg ？ kg-1 ？ min-1, P=0.011）, less ICU stay days （4.5±1.2 days vs. 5.3±1.6 day

关 键 词：重组人脑利钠肽 风湿性心脏病 心肾综合征 心脏手术 

分 类 号：R654.2[医药卫生—外科学]