摘要
目的探讨应用小剂量冻干重组人脑钠肽(lyophilized recombinant human brain natriuretic peptid,lrhBNP;商品名:新活素)治疗急性前壁心肌梗死急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心力衰竭并发低血压患者的疗效和安全性。方法选取2016年1月至2017年12月上海中医药大学附属普陀医院收治的66例急性前壁心肌梗死急诊PCI治疗后,心功能Killp′sⅢ~Ⅳ级的患者,分为对照组(34例)和lrhBNP组(32例)。对照组患者给予常规治疗;lrhBNP组患者在常规治疗的基础上加用小剂量lrhBNP。观察并比较两组患者住院期间血压、尿量、脑钠肽(brain natriuretic peptid,BNP)、左心室射血分数(left ventricular ejection fraction,LVEF)和临床症状,分析lrhBNP使用的疗效和安全性。结果与对照组比较,lrhBNP组住院期间LVEF提升幅度明显增加(16%vs. 11%,P<0.05);BNP降低幅度显著增加(49%vs. 27%,P<0.05),差异均有统计学意义。两组肌钙蛋白峰值比较,差异无统计学意义(167.90 ng/mL vs. 362.74 ng/mL,P>0.05)。lrhBNP组患者在住院期间使用lrhBNP后BNP浓度显著降低[(510.61±393.19)ng/mL vs.(1 057.93±606.10)ng/mL,P<0.05];LVEF显著提升(43%±9%vs. 36%±7%,P<0.05);速尿用量显著减少[(31.25±14.55)mg vs.(47.50±26.20)mg,P<0.05)];患者尿量明显增加[(2 476.25±705.05)mL vs.(1 670.63±613.85)mL,P<0.05],平均增加幅度58.38%;而用药前、后血尿素[(7.50±3.49)mmol/L vs.(8.91±6.82)mmol/L,P>0.05]和血肌酐浓度(71.5μmol/L vs. 70.0μmol/L,P>0.05)比较,差异无统计学意义。虽然患者使用lrhBNP后血压有所降低,但仍在可控范围内[(95.44±7.35)mmHg vs.(102.63±9.60)mmHg,P<0.05;1 mmHg=0.133 kPa]。结论小剂量lrhBNP治疗能安全且有效改善急性前壁心肌梗死、心功能KillpsⅢ~Ⅳ级、行急诊PCI治疗后并发低血压患者的心功能。
Objectives To observe the clinical efficacy and safety of lyophilized recombinant human brain natriuretic peptid(lrhBNP;Xinhuasu)for patients with acute anterior myocardial infarction with heart failure combined with hypotension after successful primary percutaneous coronary intervention(PCI).Methods Totally 66 patients with acute anterior myocardial infarction(Killp'sⅢ~Ⅳ)had all underwent successful primary PCI from January 2016 to December 2017 in Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicin were randomly assigned to lrhBNP group(n=34)and control group(n=32).Patients in control group were given conventional therapy.Patients in lrhBNP group were given lrhBNP based on conventional therapy.Blood pressure,urine volume,brain natriuretic peptid(BNP),left ventricular ejection fraction(LVEF)and clinical symptoms of both the groups were observed and compared to analyzed the clinical efficacy and safety of lrhBNP.Results Compared with control group,the increase rate of LVEF in LrhBNP group was significantly increased(16%vs.11%,P<0.05);the decrease rate of BNP was significantly increased(49%vs.27%,P<0.05).There was no significant difference in the peak value of troponin I between the two groups(167.90 ng/mL vs.362.74 ng/mL,P>0.05).In lrhBNP group,concentration of BNP[(510.61±393.19)ng/mL vs.(1 057.93±606.10)ng/mL,P<0.05]was significantly reduced and LVEF(43%±9%vs.36%±7%,P<0.05)significantly improved after the use of the lrhBNP.After the use of lrhBNP,the amount of urine[(31.25±14.55)mg vs.(47.50±26.20)mg,P<0.05)]was significantly decreased and urine volume[(2 476.25±705.05)mL vs.(1 670.63±613.85)mL,P<0.05]was significantly increased,with an average increase of 58.38%,while there was no significant change in concentration of blood urea nitrogen[(7.50±3.49)mmol/L vs.(8.91±6.82)mmol/L,P>0.05]and concentration of creatinine(71.5μmol/L vs.70.0μmol/L,P>0.05).Although the blood pressure decreased after the use of the lrhBNP,it was still under control[(95.44±7.35)mmHg vs.(102.63
作者
潘丽婷
严鹏勇
胡文瑛
刘宗军
汪志华
PAN Li-ting;YAN Peng-yong;HU Wen-ying;LIU Zong-jun;WANG Zhi-hua(Department of Cardiology,Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 210000,China)
出处
《岭南心血管病杂志》
2019年第4期435-438,共4页
South China Journal of Cardiovascular Diseases
基金
2016年度上海中医药大学附属普陀医院院级科研课题(项目编号:2016316A)
上海市医学重点专科建设计划项目-心血管内科(项目编号:ZK2015A17)
关键词
心肌梗死
心力衰竭
冻干重组人脑钠肽
myocardial infarction
heart failure
lyophilized recombinant human brain natriuretic peptid
