小剂量联合重组人脑利钠肽和沙库巴曲缬沙坦治疗老年急性心力衰竭的短期疗效  

The short-term efficacy of low-dose combined with recombinant human brain natriuretic peptide and sacubitril-valsartan in the treatment of elderly patients with acute heart failure

作　　者：崔建国[1] 梁淑芹[1] 齐洁[1] 胡孟芬 赵洁[1] 石斗飞[1] 毛艳华 宓宝斌[1] 马慧[1] 张清潭[1] CUI Jianguo;LIANG Shuqin;QI Jie;HU Mengfen;ZHAO Jie;SHI Doufei;MAO Yanhua;MI Baobin;MA Hui;ZHANG Qingtan(Department of Geriatrics,Binzhou Medical University Hospital,Binzhou 256600,China)

机构地区：[1]滨州医学院附属医院老年医学科,山东滨州256600

出　　处：《实用医学杂志》2020年第21期2984-2989,共6页The Journal of Practical Medicine

基　　金：山东省科技发展计划医药卫生项目(编号:2013YD18109)。

摘　　要：目的探讨小剂量联合重组人脑利钠肽(rhBNP)和沙库巴曲缬沙坦钠治疗老年急性心力衰竭的短期疗效及安全性。方法将纽约心功能Ⅲ-IV级合并NT-proBNP显著升高及射血分数下降的142例老年患者随机分为观察组(A组)、常规+重组人脑利钠肽组(B组)及常规治疗组(C组),分别为47例、47例和48例。所有患者根据病情应用利尿剂、地高辛及其他对症治疗。A组为在常规治疗基础上,初始3 d应用重组人脑利钠肽0.5 mg/d,同时给予沙库巴曲缬沙坦钠片,25 mg bid口服,根据血压水平滴定;B组为在常规治疗基础上初始3 d应用重组人脑利钠肽;C组为常规治疗。比较三组患者临床症状缓解程度、临床缓解时间,纽约心功能改善程度、6 min步行距离、血压改变及NT-proBNP下降程度等。结果3组患者治疗后心室率及NT-proBNP水平均较入院前显著下降(P<0.001)。A组患者治疗后舒张压均较入院时下降(P<0.001)。A组临床缓解天数均少于C组,两组比较差异有统计学意义(P<0.001);出院时6 min步行距离A组大于C组(P<0.001);出院舒张压在A组低于C组(P=0.006);治疗1周时NT-proB NP水平在A组均低于C组和B组(P<0.001);同时B组也低于C组,差异有统计学意义(P<0.001)。3组之间心功能改善程度差异无统计学意义(P=0.051)。3组患者在住院期间共发生院内死亡9例,每组3例。院内死亡患者平均年龄及入院时NT-proBNP均显著大于院内存活患者(均P<0.001);入院时心室率和EF值在院内死亡患者显著小于存活患者(均P<0.001)。结论早期小剂量联合应用rhBNP联合沙库巴曲缬沙坦钠口服可较常规治疗方案进一步改善老年急性心力衰竭患者的短期预后。Objective To explore the short-term efficacy and safety of low-dose combined with recombinant human brain natriuretic peptide and sacubitril-valsartan in the treatment of elderly patients with acute heart failure.Methods 142 elderly patients with New York Heart FunctionⅢ~Ⅳand NT-proBNP significantly increased and ejection fraction significantly decreased were randomLy divided into observation group(group A),conventional+recombinant human brain natriuretic peptide group(group B)and conventional treatment group(Group C),47 cases,47 cases and 48 cases respectively.All patients were treated with diuretics,digoxin and other symptomatic treatment according to their condition.Group A received 0.5 mg/day recombinant human brain natriuretic peptide(rhBNP)on the basis of routine treatment for the first three days,and at the same time,sacubitrilvalsartan,25 mg bid orally for the first time,titrated according to blood pressure level;group B received rhBNP for the first three days on the basis of routine treatment;group C received routine treatment.The clinical symptom relief,clinical remission time,heart function improvement,six minute walking distance,blood pressure change and NT-proBNP level were compared among the three groups.Results After treatment,the ventricular rate and NT proBNP level of the three groups were significantly lower than that before admission(P<0.001).In group A,diastolic blood pressure decreased after treatment(P<0.001).The clinical remission in group A were less than those in group C,and there were significant differences between the two groups(P<0.001).The six minute walking distance in group A was greater than that in group C(P<0.001);the diastolic blood pressure in group A was lower than that in group C(P=0.006);the NT-proBNP level in group A was lower than that in group C and group B(P<0.001)at the first week of treatment;at the same time,the NT-proBNP level in group B was lower than that in group C(P<0.001).There was no significant difference in the improvement of cardiac function among the t

关 键 词：老年 急性心力衰竭 重组人脑利钠肽 沙库巴曲缬沙坦 

分 类 号：R541.61[医药卫生—心血管疾病] R972.4[医药卫生—内科学]