Objective To observe the efficacy and prognosis of recombinant human brain natriuretic peptide ( rhBNP) and conventional treatment in acute myocardial infarction patients undergoing percutaneous coronary intervention therapy complicated by acute of left heart failure. Methods Retrospective analysis of 229 cases of hospitalized patients with acute myocardial infarction undergoing percutaneous coronary intervention therapy in 24 hours after admission, complicating with acute left ventricular failure in Shenyang Military General Hospital from June 2012 to January 2014 were enrolled and devided into: the conventional heart failure therapy group (the control group, n=122) and the rhBNP plus conventional treatment group ( the treatment group, n =107 ) , according to the patient's economic conditions and wishes. Observed improvement in heart failure symptoms before and after treatment during hospitalization and follow-up and also the 30 days and 12 months mortality. Results After 72 hrs of treatment of heart failure, both groups had decrease in heart rates, systolic blood pressure and NT-proBNP levels as compared to pre-treatment levels ( all P ﹤ 0. 05 ) . The NT-proBNP levels and heart rate of the treatment group decreased more significantly compared to the control group (both P﹤0. 05). Compared with the control group, rhBNP which to be used 72 hrs, can improve the cardiac function of AMI patients with the ratio of KillipⅡ-Ⅲ(72. 9%vs. 54. 9%, P=0. 005). There was no significant differences between two groups in in-hospital mortality and early follow-up period ( 30 days ) ( P ﹥0. 05 ) . After 12 months of follow-up, the mortality of the treatment group was lower than the control group ( 6. 5% vs. 13. 9%, P = 0. 068 ) . Through logistic regression analysis, the value of NT-proBNP and whether patients were treated with rhBNP on the basis of the routine drug were independent influencing factors for mortality of 12 months. Conclusions Additional to standard conventional therapy for acute left heart failure in patients with acute myocardial infarction undergoing PCI, rhBNP can lower the 12 months mortality and improve prognosis.%目的：观察重组人脑利钠肽( recombinant human brain natriuretic peptide,rhBNP)对急性心肌梗死( acute myocardial infarction, AMI )入院后24 h 行经皮冠状动脉介入治疗( percutaneous coronary intervention,PCI)术后并发急性左心衰竭( acute left heart failure, AHF)的疗效。方法回顾分析2012年6月至2014年1月在沈阳军区总医院住院治疗的 AMI 行 PCI 术后并发 AHF 患者229例,根据患者的经济条件及知情同意后分为常规药物治疗心力衰竭组122例(对照组)及常规药物治疗心力衰竭基础上应用rhBNP组107例(观察组)。观察两组患者治疗前后心力衰竭症状的改善情况,住院和随访30 d及12个月的死亡率。结果两组患者治疗72 h后的心率、收缩压、氨基末端B型脑钠肽前体(NT-proBNP)均较治疗前显著下降(均P﹤0.05),观察组心率、NT-proBNP较对照组下降幅度更显著(P﹤0.05),观察组Killip心功能Ⅱ~Ⅲ级改善情况(所占比率的降低幅度)显著优于对照组[78例(72.9%)比67例(54.9%), P＝0.005]。观察组住院期间[5例(4.7%)比8例(6.6%),P＝0.539]、随访30 d[7例(6.5%)比14例(11.5%),P＝0.197]、12个月[7例(6.5%)比17例(13.9%),P＝0.068]的死亡率均低于对照组。多因素logistic回归分析显示,NT-proBNP水平(OR 0.999,95%CI 0.999~1.000,P＝0.000)及应用rhBNP治疗(OR 0.084,95%CI 0.015~0.483, P＝0.006)是AMI患者PCI术后并发AHF远期(12个月)死亡率的独立影响因素。结论常规治疗基础上加用rhBNP治疗AMI患者PCI术后并发AHF与常规治疗比较,可降低12个月的死亡率,改善患者预后,值得临床推广应用。
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