重组人脑利钠肽联合托伐普坦治疗青中年急性心肌梗死合并心力衰竭的临床观察  

Clinical observation of recombinant human brain natriuretic peptide combined with tolvaptan in the treatment of acute myocardial infarction complicated with heart failure in the young and middle-aged

作　　者：李柏林[1] 邹育明 梁明俊[1] 梁春娜[1] 谢富华[2] LI Bo-lin;ZOU Yu-ming;LIANG Ming-jun;LIANG Chun-na;XIE Fu-hua(Department of Emergency Medicine,the Central Hospital of Kaiping,Jiangmen 529300,China;Department of Critical Care Medicine,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]广东省开平市中心医院急诊科,广东江门529300 [2]广州医科大学附属第二医院重症医学科,广东广州510000

出　　处：《广东医科大学学报》2018年第6期660-663,共4页Journal of Guangdong Medical University

摘　　要：目的分析比较重组人脑利钠肽(rh-BNP)联合托伐普坦治疗青中年急性心肌梗死合并心力衰竭的临床效果。方法选择青中年急性心肌梗死合并心力衰竭患者90例,随机分为对照组和观察组,每组45例。两组均采用溶栓、扩张血管、强心、抗休克等基础治疗,对照组采用rh-BNP治疗,观察组采用rh-BNP联合托伐普坦治疗。观察两组患者心功能、呼吸困难的改善情况,比较治疗前后两组患者肾功能与炎症指标的变化情况。结果两组患者治疗后的心功能和呼吸困难均得到明显改善,与对照组相比,观察组患者治疗后脑钠肽(BNP)、心功能和呼吸困难分级降低(P<0.05),动脉血氧分压(PaO2)、24 h尿量以及血清钠离子显著增高(P<0.05或0.01),左室射血分数(LVEF)、心输出量(CO)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、肌酐和血清钾离子差异没有统计学意义(P>0.05)。两组患者均没有明显不良反应(P>0.05)。结论 rh-BNP联合托伐普坦治疗青中年急性心肌梗死合并心力衰竭相较于单纯rh-BNP治疗,能更好地改善心功能和呼吸功能,对肾功能没有影响,具有良好的临床应用价值。Objective To analyze and compare the clinical effect of recombinant human brain natriuretic peptide(rhBNP)combined with tolvaptan in the treatment of acute myocardial infarction(AMI)complicated with heart failure in the young and middle-aged.Methods Ninety young and middle-aged patients with acute myocardial infarction complicated with heart failure were randomly divided into Observation Group and Control Group,45 patients in each group.All the patients were given basic treatment,such as thrombolysis,dilatation of blood vessels,cardiotonic and anti-shock.The Control Group was treated with rh-BNP while the Observation Group was treated with rh-BNP in combination with tolvaptan.The improvement in heart function and dyspnea of the two groups were observed,and the changes in renal function and inflammation indicators of the two groups were compared.Results Cardiac function and dyspnea of both groups was significantly improved after the treatment.Compared with the Control Group,the Observation Group had decreased brain natriuretic peptide(BNP),heart function grading and dyspnea grading(P<0.05)and had significantly increased blood oxygen partial pressure24-hour urine output and serum sodium ion(P<0.05 or 0.01).There was no statistical difference in left ventricular ejection fraction(LVEF),cardiac output(CO),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),creatinine and serum potassium ion(P>0.05).Conclusion Compared with basic treatment,the rhBNP combined with tolvaptan can effectively improve the cardiac function of patients,has no impact on renal function and has good clinical application value in the treatment of acute myocardial infarction complicated with heart failure.

关 键 词：急性心肌梗死 心力衰竭 重组人脑利钠肽 托伐普坦 

分 类 号：R541.6[医药卫生—心血管疾病] R542.22[医药卫生—内科学]