冻干重组人脑利钠肽治疗缺血性心肌病室性心律失常和急性心力衰竭的疗效和安全性评价  

Clinical assessment of efficacy and safety of Recombinant human brain natriuretic therapy on Ventricular arrhythmias(VAs)and Acute Heart failure in Ischemic Cardiomyopathy

作　　者：傅涛[1] 荆忱[1] 徐佳[1] 袁鹰[1] 陈宏[1] 陈杰[1] 

机构地区：[1]空军航空医学研究所附属医院心脏内科,北京100089

出　　处：《北京医学》2017年第6期607-610,614,共5页Beijing Medical Journal

摘　　要：目的评价治疗冻干重组人脑利钠肽治疗缺血性心肌病患者室性心律失常和急性心力衰竭的临床疗效和安全性。方法选择心功能Ⅲ-Ⅳ级缺血性心肌病合并室性心律失常及急性心力衰竭患者110例,随机分成治疗组与对照组。治疗组58例,给予冻干重组人脑利钠肽和常规缺血性心肌病治疗,同时加用重组人脑利钠肽,首次负荷剂量1.5μg/kg静脉注射,然后按0.0075μg/(kg·min)剂量持续静脉泵入,持续72 h。对照组52例,常规缺血性心肌病药物治疗,观察2周;在实验开始和2周后进行心率、血压、动态心电图、超声心动图、心胸比率、肾功能以及心肌标志物及NT-pro-BNP水平的检查;并观察了2组不良反应和发生率死亡率。结果两组控制室性心律失常的总有效率分别是70.28%和50.32%,差异有统计学意义(P<0.05),左室舒张末容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)和E/A(舒张早期血流速度峰值E峰/舒张晚期血流速度峰值A峰)改善治疗组优于对照组(P<0.05);心率、血压、心胸比率在治疗前后以及两组之间比较有统计学意义(P<0.05);同时治疗前和治疗后2周监测肾脏功能和心肌标志物水平,治疗前后以及两组之间比较无统计学意义(P>0.05);同时治疗前和治疗后2周监测NT-pro-BNP水平,治疗前后以及两组之间比较无统计学意义(P>0.05);不良反应无统计学意义(P>0.05),死亡率有统计学意义(P<0.05)。结论冻干重组人脑利钠肽治疗缺血性心肌病患者室性心律失常和急性心力衰竭有一定效果,可防止恶性心律失常的发生,使左室容积缩小,左室射血分数升高;心率和血压改善,心胸比例下降,NT-pro-BNP下降,降低缺血性心肌病患者的猝死率,不良反应小。Objective To assess the efficacy and safety of Recombinant human brain natriuretic therapy on Ventricular Arrhythmias（VAs） and Acute Heart failure in Patients with Ischemic cardiomyopathy. Methods 110 patients with ventricular Arrhythmias（Vas） and acute heart failure in Ischemic cardiomyopathy were randomly divided into two groups. The therapeutic group（group A, 58 patients ）were treated with Recombinant human brain natriuretic and conventional treatment of ischemic heart disease. The therapeutic group was added rhBNP, the loading dose was 1.5μg/kg intravenous injection, and then 0.0075μg/（kg·min） was continuous infused with intravenous pumpfor 72 h; The comparison group （group B, 52 patients） were treated with routine ischemic cardiomyopathy treatment. The echocardiography, dynamic elec-trocardiogram（Holter）, ECG, Heart rate, Blood pressure, heart chest area ratio; cadiac damage marker, NT-pro-BNP, Re- nal function were compared before and after the treatment. Results After patients had received treatment for 2 weeks in hospital, the occurrence of Ventricular Arrhythmias（VAs） in the therapeutic group was significantly reduced than those in the control group（P 〈 0.05）; The left ventricular function and structure were improved significantly in both groups （P 〈 0.05）, and the observation group were improved more significantly than the control group （P 〈 0.05）; The Heart rate, blood pressure and heart chest area ratio as well as comparison between the two groups was significantly different （P 〈 0.05）. The change of renal function（including the serum creatinine, blood urea nitrogen） and Cardiac damage marker （CK- mb TnI Myo） was not significantly different between the two groups, neither no changes before and after the treatment （ P 〉 0.05）; NT-pro-BNP was significantly different between the two groups （P 〈 0.05）. Adverse reactions were not significantly different between the two groups （P 〉 0.05）. There was significant differences in mo

关 键 词：冻干重组人脑利钠肽 室性心律失常 急性心力衰竭 缺血性心肌病 

分 类 号：R541[医药卫生—心血管疾病] R542.2[医药卫生—内科学]