重组人脑利钠肽对急性失代偿性心力衰竭患者血流动力学及心功能的影响

摘要

目的 探讨重组人脑利钠肽(rhBNP)对急性失代偿性心力衰竭(ADHF)患者血流动力学及心功能的影响.方法 选取2017年1~6月期间大连大学附属中山医院循环四科收治的60例ADHF患者,按随机数表法分为对照组与观察组,每组30例,两组患者均常规治疗,对照组同时给予硝酸甘油静脉泵注,观察组同时给予r hBNP静脉泵注,观察用药前、用药后1 h、12 h、24 h、48 h、72 h时两组患者心率、呼吸、收缩压、平均动脉压(MPAP)、心输出量(CO)、平均肺毛细血管楔压值(MPCWP),用药前及用药72 h后左心室舒张末内径(LVEDD)及左心室射血分数(LVEF)、脑利钠肽(BNP)水平.结果 观察组患者用药后1 h、12 h、24 h、48 h、72 h时心率、呼吸及收缩压较用药前明显下降,对照组用药后12 h、24 h、48 h、72 h以上指标较用药前也明显下降,差异均有统计学意义(P<0.05);用药后1 h时观察组患者的以上指标低于对照组,差异均有统计学意义(P<0.05);观察组患者用药后1 h、12 h、24 h、48 h、72 h时MPAP和MPCWP较用药前明显下降、CO较用药前升高,差异均有统计学意义(P<0.05);对照组患者用药后12 h、24 h、48 h、72 h时MPAP和MPCWP较用药前明显下降、CO较用药前升高,差异均有统计学意义(P<0.05);用药后1 h时观察组患者的MPAP和MPCWP低于对照组,CO高于对照组,差异均有统计学意义(P<0.05);两组患者治疗后LVEF较治疗前明显升高,BNP较治疗前明显下降,且治疗后LVEF升高、BNP下降幅度观察组优于对照组,差异均有统计学意义(P<0.05);观察组患者的治疗总有效率为93.33%,高于对照组的73.33%,差异有统计学意义(P<0.05).结论 rhBNP治疗AD HF能更快地改善患者血流动力学及心功能,提高临床治疗效果.%Objective To investigate the effect of recombinant human brain natriuretic peptide(rhBNP)on the hemodynamics and cardiac function in patients with acute decompensated heart failure(ADHF).Methods From Janu-ary 2017 to June 2017,60 ADHF patients in Fourth Department of Circulation,the Affiliated Hospital of Dalian Univer-sity were randomly divided into the control group and observation group according to random number table,with 30 pa-tients in each group.Based on conventional treatment,the control group was given intravenous infusion of nitroglycerin intravenously,and the observation group was given intravenous infusion of rhBNP.The heart rate,respiration,systolic blood pressure,mean arterial pressure(MPAP),cardiac output(CO),median pulmonary capillary wedge pressure value(MPCWP) before medication and at 1 h,12 h,24 h,48 h,72 h after medication were observed,as well as left ventricular end diastolic di-ameter(LVEDD),left ventricular ejection fraction(LVEF)and brain natriuretic peptide(BNP)levels before medication and at 72 h after medication.Results The heart rate,respiration,systolic blood pressure at 1 h,12 h,24 h,48 h,72 h after medi-cation were significantly lower than those before medication in the observation group(P<0.05),and the indexes at 12 h, 24 h,48 h,72 h after medication were significantly lower than those before medication in the control group(P<0.05). 1 h after medication,the above indexes in the observation group were significantly lower than those in the control group (P<0.05).MPAP and MPCWP at 1 h,12 h,24 h,48 h,72 h after medication were significantly lower than those before medication in the observation group(P<0.05),while CO were significantly higher(P<0.05).MPAP and MPCWP at 12 h, 24 h,48 h,72 h after medication were significantly lower than those before medication in the control group(P<0.05), while CO were significantly higher(P<0.05).At 1 h after medication,MPAP and MPCWP in the observation group were significantly lower than those in the control group(P<0.05),and CO in the observation group were significantly higher (P<0.05).LVEF after medication were significantly increased compared with those before medication in the two groups, and BNP were significantly decreased(P<0.05),with the change in the observation group more significant than that in the control group (P<0.05). The total effective rate of the observation group was 93.33%, significantly higher than 73.33% in the control group(P<0.05).Conclusion rhBNP in the treatment of ADHF can improve the patient's hemody-namic and cardiac function faster and improve the therapeutic effect.