新活素防治心血管外科围术期伴急性失代偿性心力衰竭的效果和安全性  

Effects and Safety of Recombinant Human Brain Natriuretic Peptide on Peri-operative Patients of Cardiovascular Surgery with Acute Decompensated Heart Failure

作　　者：朴虎林[1] 郝燕丽 刘可妍 李丹[1] PIAO Hu-lin;HAO Yan-li;LIU Ke-yan(Department of Cardiovascular Surgery,The Second Hospital of Jilin University,Changchun 130041,China)

机构地区：[1]吉林大学第二医院心血管外科,吉林长春130041

出　　处：《吉林医学》2022年第9期2419-2423,共5页Jilin Medical Journal

摘　　要：目的:探讨新活素(重组人脑利钠肽)对心血管外科围手术期伴急性失代偿性心力衰竭患者的临床治疗效果及安全性。方法:选取行心脏和大血管手术术后出现急性失代偿性心力衰竭患者120例的相关临床资料,在接受常规药物治疗基础上,根据是否接受新活素治疗将患者分为对照组和新活素组各60例。比较两组患者左心室射血分数、血肌酐水平、BNP水平及尿量,观察两组患者治疗后不良反应的发生情况、住院时间和主要心血管不良事件的发生率,总结新活素防治心血管外科围手术期伴急性失代偿性心力衰竭的效果和安全性。结果:新活素组治疗72 h平均左心室射血分数(LVEF)和平均每小时尿量明显高于治疗前,平均B型脑利钠肽(BNP)水平明显低于治疗前,差异均有统计学意义(P<0.05)。对照组治疗72 h平均LVEF和平均每小时尿量略高于治疗前,平均BNP水平略低于治疗前,但差异均无统计学意义(P>0.05)。新活素组治疗24 h血肌酐值略高于治疗前,差异无统计学意义(P>0.05),治疗48 h、72 h均明显低于治疗前,差异有统计学意义(P<0.05);而对照组治疗24 h血肌酐值略高于治疗前,差异无统计学意义(P>0.05),治疗48 h则明显高于治疗前,差异有统计学意义(P<0.05),治疗72 h仍略高于治疗前,但差异均无统计学意义(P>0.05)。治疗期间新活素组患者均有不同程度血压下降,其中8.33%(5/60)患者血压低于90/60 mmHg。新活素组平均住院时间略短于对照组,30 d内MACE事件发生率略低于对照组,差异无统计学意义(P>0.05)。结论:对于心血管外科围手术期伴急性失代偿性心力衰竭患者,新活素的早期应用可明显改善患者心、肾功能,且不会增加患者MACE事件的发生率,但低血压发生率较高。Objective To investigate the clinical efficacy and safety of recombinant human brain natriuretic peptide(rhBNP)on perioperative patients of cardiovascular surgery with acute decompensated heart failure(ADHF).Method The relevant clinical data of 120 patients with acute decompensated heart failure after cardiac and macrovascular surgery in the cardiovascular surgery were collected. On the basis of receiving conventional drug treatment, the patients were divided into control group and neoactivin group according to whether they received neoactivin treatment.Efficacy and safety of rhBNP in treatments of peri-operative ADHF were evaluated by comparing LVEF,plasma creatine level, plasma BNP level, urine amount, average length of stay in hospital(ALOS)and prevalence of adverse effects, and major adverse cardiovascular events between control group and neoactivin group.Results Mean LVEF and Mean urine amount per hour after 72 h treatment in the neoactivin group were significantly higher than those before treatment(P<0.05).There were no significant differences in the control group about mean LVEF and mean per hour urine amount(P>0.05).Mean plasma BNP levels in theneoactivin group was significantly lower than those before treatment(P<0.05).Mean plasma creatinine levels after 48 h and 72 h treatment in the neoactivin group was significantly lower than those before treatment(P<0.05).The total in hospital days of the neoactivin group was a little shorter than that of the control group(P>0.05).8.33% patients in the neoactivin group had experienced hypotension with their blood pressures under 90/60 mmHg during treatment. The occurrence of major adverse cardiovascular events(MACE)within 30 d of the neoactivin group was a little lower than that of the control group(P>0.05).Conclusion The rhBNP therapy improves the cardiac and renal function of perioperative patients of cardiovascular surgery with ADHF,with a higher incidence rate of hypotension.

关 键 词：新活素(重组人脑利钠肽) 心衰 心血管外科 围术期 安全性 

分 类 号：R541.6[医药卫生—心血管疾病]