不同剂量重组人脑利钠肽联合比索洛尔在老年急性心肌梗死患者PCI后的应用对比  

Comparison of Different Doses of Recombinant Human Brain Natriuretic Peptide Combined with Bisoprolol in Elderly Patients with Acute Myocardial Infarction after PCI

作　　者：王倩[1] 任琳[2] 陈皓 李芳[1] 张鹏宇[1] 王小娟[1] Wang Qian;Ren Lin;Chen Hao;Li Fang;Zhang Pengyu;Wang Xiaojuan(Department of Geriatric,First Hospital of Qinhuangdao,Qinhuangdao 066000;Department of Cardiovascular,First Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院老年病科,秦皇岛066000 [2]秦皇岛市第一医院心血管内科,秦皇岛066000

出　　处：《国际老年医学杂志》2024年第2期167-172,共6页International Journal of Geriatrics

基　　金：秦皇岛市科技计划项目(201805A096)。

摘　　要：目的 比较不同剂量的重组人脑利钠肽(rhBNP)联合比索洛尔在老年急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后的应用价值。方法 选取2020年1月—2022年10月秦皇岛市第一医院收治的138例老年AMI患者进行前瞻性研究,按照随机数字表法分为三组,各46例。各组均行PCI和比索洛尔治疗,术前2 h,小剂量组给予1.5μg/(kg·min)的rhBNP,中剂量组给予2.0μg/(kg·min)的rhBNP,大剂量组给予3.0μg/(kg·min)的rhBNP。比较各组治疗前后心功能[左室射血分数(LVEF)、心脏指数(CI)、每分钟搏出量(SV)、血浆脑钠肽(BNP)]、心电生理指标[窦性心搏RR间期标准差(SDNN)、相邻RR间期差值均方根(RMSSD)、低频段/高频段(LF/HF)]、肾功能[血肌酐(Scr)、β2-微球蛋白(β2-MG)、血尿素氮(BUN)]、核因子E2相关因子2/血红素加氧酶-1(Nrf2/HO-1)通路及治疗后不良反应、心血管不良事件的发生情况。结果 治疗72 h后,大剂量组LVEF、CI、SV、SDNN、RMSSD及Nrf2、HO-1蛋白水平均高于中剂量组和小剂量组(P<0.05),大剂量组的血浆BNP水平、LF/HF低于中剂量组和小剂量组(P<0.05);治疗72 h后,中剂量组和小剂量组的心功能、心电生理指标、Nrf2/HO-1信号通路的蛋白比较差异均无统计学意义(P>0.05)。治疗前、治疗72 h后,各组血清Scr、β2-MG、BUN水平比较差异均无统计学意义(P>0.05),各组不良反应总发生率、心血管不良事件的总发生率比较差异均无统计学意义(P>0.05)。结论 rhBNP联合比索洛尔应用于老年AMI患者PCI后疗效确切,大剂量rhBNP可显著改善心功能、心率变异性,可能与激活Nrf2/HO-1通路有关,且对肾功能损害、不良反应及心血管不良事件无明显影响。Objective To compare the value of different doses of recombinant human brain natriuretic peptide(rhBNP)combined with bisoprolol after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI).Methods A total of 138 elderly patients with AMI in First Hospital of Qinhuangdao from January 2020 to October 2022 were prospectively selected,they were divided into 3 groups with 46 cases in each group by random number table.All groups were treated with PCI and bisoprolol,2 hours before surgery,the low-dose group received 1.5μg/(kg·min)rhBNP,the medium-dose group received 2.0μg/(kg·min)rhBNP,and the high-dose group received 3.0μg/(kg·min)rhBNP.Cardiac function[left ventricular ejection fraction(LVEF),cardiac index(CI),stroke volume per minute(SV),plasma brain natriuretic peptide(BNP)],electrocardiographic parameters[standard diviation of NN intervals(SDNN),root mean square of successive RR interval differences(RMSSD),low frequency band/high frequency band(LF/HF)],renal function[serum creatinine(Scr),β2-microglobulin(β2-MG),blood urea nitrogen(BUN)],nuclear factor E2-related factor 2/heme oxygenase-1(Nrf2/HO-1)pathway were compared between the groups before and after treatment.The occurrence of adverse reactions and adverse cardiovascular events after treatment were compared between the groups.Results After 72 h of treatment,LVEF,CI,SV,SDNN,RMSSD,Nrf2 and HO-1 protein levels in the high-dose group were higher than those in the medium-dose and low-dose groups(P<0.05),and plasma BNP levels and LF/HF in the high-dose group were lower than those in the medium-dose and low-dose groups(P<0.05);after 72 h of treatment,there were no significant differences in cardiac function,electrophysiological parameters,and proteins of the Nrf2/HO-1 signaling pathway between the medium-dose and low-dose groups(P>0.05).Before treatment and 72 h after treatment,there was no significant difference in serum Scr,β2-MG and BUN levels between the groups(P>0.05).There was no significant difference in the

关 键 词：重组人脑利钠肽 比索洛尔 急性心肌梗死 心功能 核因子E2相关因子2 血红素加氧酶-1 

分 类 号：R542.22[医药卫生—心血管疾病]