摘要
目的观察65岁以上老年难治性心力衰竭并室性心律失常应用不同剂量重组人脑利钠肽(rhBNP)治疗后的临床效果,初步分析用药安全性及其量效作用。方法选取2019年12月~2021年12月由武警辽宁省总队医院及北部战区总医院收治的76例65岁以上的老年难治性心力衰竭并室性心律失常患者,进行回顾性分析。根据治疗方案不同分为大剂量组和小剂量组,各38例。两组均给予休息、吸氧、西地兰强心、呋塞米利尿、硝酸异山梨酯扩冠、血管紧张素转换酶抑制剂类药物等基础治疗。大剂量组和小剂量组在上述治疗的同时,分别给予负荷量3.0μg/kg和1.5μg/kg的rhBNP静脉注射5 min,随后持续静脉泵输注72 h。比较两组治疗前后室性早搏、成对室性早搏及短阵室速发作次数,心功能改善情况,24 h尿量,血清Na+浓度、血浆N末端B型利钠肽前体(NT-proBNP)水平,左室射血分数(LVEF),血管收缩压(SBP)等指标。结果治疗72 h后,小剂量组室性早搏、成对室性早搏及短阵室速发作次数少于大剂量组,差异有统计学意义(P<0.05);两组心功能改善总有效率比较,差异无统计学意义(P>0.05)。治疗后大剂量组24 h尿量、LVEF高于小剂量组,血清Na+浓度、血浆NT-proBNP水平及SBP低于小剂量组,差异有统计学意义(P<0.05)。结论rhBNP治疗65岁以上老年难治性心力衰竭并室性心律失常疗效确切,较大剂量rhBNP可显著降低血浆NT-proBNP水平,提高LVEF,但对于心功能改善与小剂量rhBNP比较无差异,小剂量rhBNP控制室性心律失常效果更佳,安全性更高。
Objective To observe the clinical efficiency of different doses of recombinant human brain natriuretic peptide(rhBNP)in the treatment of older patients with refractory heart failure complicated by ventricular arrhythmia and analyze the safety and dose-effect of rhBNP.Methods A retrospective analysis was conducted on the clinical data of 76 patients(>65 years old)with refractory heart failure complicated by ventricular arrhythmia treated in Liaoning Provincial Armed Police Force Corps Hospital and General Hospital of Northern Theater Command from December 2019 to December 2021.The patients were divided into the high-dose group(38 cases)and the low-dose group(38 cases)according to the different therapeutic regimens.Both groups received the conventional treatment such as rest,supplemental oxygen,cardiotonic agent cedilandid,diuretic agent furosemide,vasodilator isosorbide dinitrate,angiotensin converting enzyme inhibitor(ACEI),etc.Based on the conventional treatment,the high-dose group and the low-dose group received additionally intravenous injection of 3.0μg/kg,and 1.5μg/kg rhBNP for 5 min,respectively,followed by continuous infusion by intravenous pump for 72 hours.The frequencies of ventricular premature beats,pair ventricular premature beats and paroxysmal ventricular tachycardia;cardiac function,24-h urine volume,serum sodium concentration,plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP)level,left ventricular ejection fraction(LVEF),systolic blood pressure(SBP)were compared between the two groups before and after treatment.Results After 72 hours of treatment,the frequencies of ventricular premature beats,pair ventricular premature beats and paroxysmal ventricular tachycardia in the low-dose group were less than those in the high-dose group(P<0.05).There was no significant difference in overall response rate of cardiac function improvement between the two groups(P>0.05).After treatment,24-h urine volume and LVEF in the high-dose group were more than those in the low-dose group,while the serum sodiu
作者
李志伟
叶圣权
高峰
孟强
张珊珊
赵丽军
丁建
王祖禄
Li Zhiwei;Ye Shengquan;Gao Feng;Meng Qiang;Zhang Shanshan;Zhao Lijun;Ding Jian;Wang Zulu(Department of Emergency,Liaoning Provincial Armed Police Force Corps Hospital,Shenyang 110034;Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016)
出处
《国际老年医学杂志》
2022年第4期410-414,共5页
International Journal of Geriatrics
基金
国家重点研发计划精准医学研究重点专项(2016YFC0900900)。
关键词
重组人脑利钠肽
心力衰竭
室性心律失常
Recombinant human brain natriuretic peptide
Heart failure
Ventricular arrhythmia
