新活素治疗利尿剂抵抗的高龄急性心力衰竭患者的临床观察  

Clinical observation of neoactivin in elderly patients with acute heart failure complicated with diuretic resistance

作　　者：姚璐 田国祥[1] 陈艳梅 毕磊 刘立新[1] 武云涛 Yao Lu;Tian Guoxiang;Chen Yanmei;Bi Lei;Liu Lixin;Wu Yuntao(不详;Department of Geriatrics,the 7th Medical Center of the People's Liberation Army General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心老年医学科,北京100700

出　　处：《中国循证心血管医学杂志》2022年第6期714-716,726,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨新活素(冻干重组人脑利钠肽)治疗利尿剂抵抗的高龄急性心力衰竭患者的临床效果。方法选择2021年1月至2021年10月于解放军总医院第七医学中心老年医学科住院的16例高龄急性心力衰竭患者为观察对象(年龄≥85岁),所有患者给予常规抗心力衰竭治疗,当患者产生利尿剂抵抗时加用新活素(起始剂量为0.005μg/kg·min),连续静脉滴注7~10 d,动态监测患者的血压、心率、尿量、B型脑钠肽(BNP)、肾功能(肌酐、尿素氮)、离子(血清钾、血清钠)的变化,并记录患者用药后的相关不良反应。结果治疗后患者BNP水平显著下降,尿量逐渐增多,与治疗前相比上述差异均具有统计学意义(P<0.05)。患者的血压、心率、肾功能(肌酐、尿素氮)、离子(血清钾、血清钠)水平与治疗前相比均无明显变化(P>0.05)。整个观察期间发生低血压1例,将新活素减慢静脉泵入速度后患者的收缩压可维持在100 mmHg(1 mmHg=0.133kPa)以上,未影响继续用药。结论高龄急性心力衰竭患者当存在利尿剂抵抗时加用新活素后,能明显改善患者心功能,增加尿量,且不影响患者的血压、心率及肾功能和离子水平。用药期间不良反应少,具有很好的安全性。但本研究样本量较少,仅对新活素治疗利尿剂抵抗的高龄急性心力衰竭患者的疗效作初步评判,今后需增加样本量及观察时间,为其在已存在利尿剂抵抗的急性心力衰竭人群中的应用提供更多临床参考。Objective To investigate the clinical effect of neoactivin(lyophilized recombinant human brain natriuretic peptide)in the treatment of diuretic resistant elderly patients with acute heart failure.Methods 16 elderly patients with acute heart failure hospitalized in the geriatrics department of the seventh medical center of the PLA General Hospital from January 2021 to October 2021 were selected as the observation objects(age≥85 years).All patients were given routine anti heart failure treatment.When the patients developed diuretic resistance,neoactivin(initial 0.005μg/kg·min)was added,and intravenous drip was continued for 7~10 days,The changes of blood pressure,heart rate,urine volume,BNP,renal function and ions(serum potassium and serum sodium)were dynamically monitored,and the related adverse reactions of all patients were recorded.Results After treatment,the BNP level decreased significantly and the urine volume increased gradually.Compared with before treatment,the above differences were statistically significant(P<0.05).There were no significant changes in blood pressure,heart rate,renal function(creatinine,urea nitrogen)and ion(serum potassium and serum sodium)levels compared with those before treatment(P>0.05).Hypotension occurred in 1 case during the whole observation period.After neoactivin slowed down the intravenous pumping speed,the systolic blood pressure of the patient could be maintained above 100 mmHg,which did not affect the continued use of drugs.Conclusion When there is diuretic resistance in elderly patients with acute heart failure,the addition of neoactivin can significantly improve the patient's cardiac function,increase urine output,and do not affect the patient's blood pressure,heart rate,renal function and ion level.There are few adverse reactions during medication,which has good safety.However,due to the small sample size of this study,we can only make a preliminary evaluation on the efficacy of neoactivin in the treatment of elderly patients with acute heart failure with diuretic r

关 键 词：冻干重组人脑利钠肽 急性心力衰竭 高龄 利尿剂抵抗 

分 类 号：R542.22[医药卫生—心血管疾病]