动态监测N末端B型钠尿肽前体下应用β受体阻滞剂治疗慢性心力衰竭的临床效果  

Clinical efficacy of beta blockers under dynamic monitoring of N-terminal pro-B-type natriuretic peptide for chronic heart failure

作　　者：吴杰华[1] 温丽娜[1] 张先位[1] 陈雪萍[1] 赵春丽[1] WU Jie-hua;WEN Li-na;ZHANG Xian-wei;CHEN Xue-ping;ZHAO Chun-li(The Second Department of Cardiovascular Disease,Minzu Hospital Affiliated to Guangxi Medical University,Nanning 530001,China)

机构地区：[1]广西医科大学附属民族医院心内二科,南宁市530001

出　　处：《广西医学》2018年第10期1164-1166,1174,共4页Guangxi Medical Journal

摘　　要：目的探讨动态监测N末端B型钠尿肽前体(NT-proBNP)下应用β受体阻滞剂治疗慢性心力衰竭的临床效果。方法选取82例慢性心力衰竭患者,随机分为研究组和对照组各41例。两组均给予常规治疗,研究组根据NT-proBNP动态监测水平制定美托洛尔用药方案,对照组根据患者临床表现及影像学检查结果制定美托洛尔用药方案。两组患者均随访1年,比较治疗前及治疗后1年末的心率变异性,以及心血管性死亡率和复发再住院率。结果治疗后,研究组患者的正常RR间期的标准差(SDNN)、相邻5 min RR间期平均值的标准差(SDANN)均较前升高,而对照组的SDNN、SDANN、相邻RR间期差值的均方根、相邻RR间期>50 ms占全部窦性心搏的比例均较前降低且低于研究组(均P<0.05)。研究组心血管性死亡率及复发再住院率均低于对照组(均P<0.05)。结论对慢性心力衰竭患者进行NT-proBNP动态监测能有效指导β受体阻滞剂的合理使用,改善患者的心脏自主神经功能及预后。Objective To investigate the clinical efficacy of beta blockers under dynamic monitoring of N-terminal pro-B-type natriuretic peptide（ NT-proBNP） for chronic heart failure. Methods Eighty-two patients with chronic heart failure were enrolled,and were randomly divided into study group and control group,with 41 cases in each group. Both groups received conventional therapy. In the study group,the therapeutic regimen of metoprolol succinate was made after dynamically monitoring of NT-proBNP level. In the control group,the therapeutic regimen was made according to the clinical features and imaging results of the patients. The two groups were followed up for1 year. The heart rate variability before treatment and at 1 year after treatment,cardiovascular mortality,and rehospitalization rate due to recrudescence were compared between the two groups. Results After treatment,the standard deviation of all normal sinus RR intervals（ SDNN） and the standard deviation of the average normal sinus RR intervals for all 5 minute segments（ SDANN） increased in the study group compared to the values before treatment,but the SDNN,SDANN,root mean square of successive differences in normal to normal RR intervals,and percentage of normal RR-interval with duration more than 50 ms different from previous normal RR-interval decreased in the control group compared to the values before treatment and in the study group（ all P〈0. 05）. The cardiovascular mortality and rehospitalization rate due to recrudescence were lower in the study group than those in the control group（ all P〈0. 05）. Conclusion For the patients with chronic heart failure,dynamically monitoring of NT-proBNP level can effectively conduct the proper use of beta blockers and improve the cardiac autonomic nerve function and prognosis of the patients.

关 键 词：慢性心力衰竭 N末端B型钠尿肽前体 Β受体阻滞剂 心率变异性 预后 

分 类 号：R541.6[医药卫生—心血管疾病]