重组人脑钠肽联合硝普钠对难治性心力衰竭预后的疗效观察  

Curative effect of recombinant human brain natriuretic peptide combined with sodium nitroprusside on prognosis of refractory heart failure

作　　者：郑云龙[1] 梁普博[1] 苏丹霞[1] Zheng Yunlong;Liang Pubo;Su Danxia(Department of Cardiovascular Medicine,Agribusiness Central Hospital,Guangdong Province,Zhanjiang 524002,China)

机构地区：[1]广东省农垦中心医院心血管内科,湛江524002

出　　处：《中国循证心血管医学杂志》2018年第8期932-935,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：2016年度湛江市非资助科技攻关计划项目(2016B01155)

摘　　要：目的探讨重组人脑钠肽(rhBNP)联合硝普钠(SNP)对难治性心力衰竭(RHF)预后的临床疗效,并分析影响难治性心力衰竭的危险因素。方法选取2011年1月~2016年6月于广东省农垦中心医院心内科住院的RHF患者116例,随机分为观察组(rhBNP+SNP)、对照组(SNP)各58例,观察给药前后液体出入量、血流动力学改变及血氧饱和度、临床症状等指标的变化,并记录不良事件,同时运用Logistic回归分析影响难治性心力衰竭的可能危险因素。结果与对照组比较,观察组24 h总尿量和72 h后临床疗效均高于对照组,差异均有统计学意义(P<0.05);观察组给药1 h后、24 h后肺毛细血管楔压(PCWP,P<0.05),1 h、12 h、24 h中心静脉压(P<0.05),1 h后心输出量(CO,P<0.05)均有显著差异。观察组较对照组心脏左室射血分数(LVEF)明显升高(P<0.05);观察组与对照组药物不良反应发生率比较差异无统计学意义(P>0.05);Logistic回归分析显示心肌病、心功能分级及心肌梗死是影响难治性心力衰竭的危险因素。结论 Rh-BNP联合SNP治疗RHF能显著改善患者的血流动力学指标,提高LVEF,改善临床症状,且安全性高。影响难治性心力衰竭的因素主要有心功能分级、心肌梗死及心肌病等。Objective To investigate the clinical efficacy of recombinant human brain natriuretic peptide(rhBNP)combined with sodium nitroprusside(SNP)on prognosis of refractory heart failure(RHF),and analyze risk factors affecting on RHF.Methods RHF patients(n=116)were chosen from the Department of Cardiovascular Medicine of Agribusiness Central Hospital of Guangdong Province from Jan.2011 to June 2016,and the randomly divided into observation group and control group(each n=58).The changes of intake and output volume of liquid,hemodynamics,oxygen saturation(SPO2)and clinical symptoms and adverse events were observed,and adverse events were recorded before and after treatment.Meanwhile the possible risk factors affecting on RHF were analyzed by using Logistic regression analysis.Results The total urine volume for 24 h and clinical efficacy after 72 h were higher in observation group than those in control group(P<0.05).The indexes of pulmonary capillary wedge pressure(PCWP)after 1 h and 24 h,central venous pressure(CVP)after 1 h,12 h and 24 h,and cardiac output(CO)after1 h had significant difference between 2 groups(all P<0.05).The level of left ventricular ejection fraction(LVEF)increased significantly in observation group compared with control group(P<0.05).The difference in incidence of adverse reactions had no statistical significance between 2 groups(P>0.05).The results of Logistic regression analysis showed that cardiomyopathy,NYHA classification and myocardial infarction were risk factors affecting RHF.Conclusion Rh-BNP combined with SNP can significantly improve the indexes of hemodynamics,promote level of LVEF and relieve clinical symptoms with higher safety in RHF patients.The risk factors affecting RHF include NYHA classification,myocardial infarction and cardiomyopathy.

关 键 词：重组人脑钠肽 硝普钠 难治性心力衰竭 

分 类 号：R541.61[医药卫生—心血管疾病]