重组人脑利钠肽联合左西孟坦治疗急性失代偿性心力衰竭的临床观察

发布时间：2018-07-05 18:43

本文选题：急性失代偿性心力衰竭 + 重组人脑利钠肽　；参考：《中国药房》2016年29期

【摘要】：目的:观察重组人脑利钠肽(rh BNP)联合左西孟坦治疗急性失代偿性心力衰竭(ADHF)的临床疗效及安全性。方法:采用回顾性研究方法,将120例ADHF患者的临床资料按治疗方案不同分为观察组和对照组,各60例。对照组患者在常规治疗的基础上给予冻干rh BNP,首先以0.15μg/kg的剂量静脉冲击,再以维持剂量0.007 5μg/(kg·min)连续静脉泵注24~72 h;观察组患者在对照组治疗基础上给予负荷剂量12μg/(kg·min)左西孟坦注射液静脉滴注10 min,再以维持剂量0.1μg/(kg·min)静脉泵注24 h,根据患者的临床表现可酌情调整剂量。记录两组患者的生命体征、血流动力学和超声心动图指标、呼吸困难好转率、血浆BNP浓度、尿量及不良反应发生情况。结果:除对照组患者在治疗后1 h的生命体征和血流动力学指标变化不明显外,两组患者治疗后各时间点的心率(HR)、呼吸频率(RR)、收缩压(SBP)、平均肺动脉压(MPAP)和平均肺毛细血管楔压(MPCWP)均明显低于治疗前,血氧饱和度(Sa O2)和心输出量(CO)均明显高于治疗前,差异均有统计学意义(P0.05);观察组患者在治疗后1、2、4 h的HR、RR、SBP、MPAP和MPCWP均明显低于对照组,Sa O2和CO均明显高于对照组,差异均有统计学意义(P0.05),其余各时间点的生命体征和血流动力学指标组间比较,差异无统计学意义(P0.05)。治疗后48 h,两组患者的左室射血分数均较治疗前升高,血浆脑利钠肽浓度均较治疗前降低,且观察组患者较对照组改善程度更明显,差异均有统计学意义(P0.05)。观察组患者治疗后24、48 h的尿量均明显高于对照组,差异均有统计学意义(P0.05)。两组患者治疗后各时间点的呼吸困难好转率及不良反应发生率比较,差异均无统计学意义(P0.05)。结论:rh BNP联合左西孟坦能有效改善ADHF患者的生命体征、血流动力学和超声心动图指标及呼吸困难症状,增加尿量,降低血浆BNP浓度,且安全性较高。
[Abstract]:Aim: to observe the clinical efficacy and safety of recombinant human brain natriuretic peptide (rh BNP) combined with levosimentam in the treatment of acute decompensated heart failure (ADHF). Methods: the clinical data of 120 patients with ADHF were divided into observation group and control group. Patients in the control group were given freeze-dried rh BNPs on the basis of routine therapy. The patients in the observation group were given a loading dose of 12 渭 g / (kg min) for 10 minutes and a maintenance dose of 0.1 渭 g / (kg min) for 24 h after continuous intravenous injection of 0.007 渭 g / (kg min) for 72 h, and the patients in the observation group were given a dose of 12 渭 g / (kg min) for 10 minutes. Performance can be adjusted as appropriate. Vital signs, hemodynamic and echocardiographic parameters, improvement rate of dyspnea, plasma BNP concentration, urine volume and adverse reactions were recorded. Results: the changes of vital signs and hemodynamic indexes in the control group were not obvious at 1 hour after treatment. Heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), mean pulmonary artery pressure (MPAP) and mean pulmonary capillary wedge pressure (MPCWP) were significantly lower than those before treatment, and blood oxygen saturation (SaO2) and cardiac output (CO) were significantly higher than those before treatment. There was significant difference between the two groups (P0.05), the values of HRRRRSBP MPAP and MPCWP in the observation group were significantly lower than those in the control group (P 0.05), and were significantly higher in the observation group than in the control group. The differences were statistically significant (P0.05), the other time points of vital signs and hemodynamic indicators of comparison between groups, the difference was not statistically significant (P0.05). 48 hours after treatment, the left ventricular ejection fraction (LVEF) in both groups was higher than that before treatment, and the plasma BNP concentration was lower than that before treatment, and the improvement was more obvious in the observation group than in the control group (P0.05). The urine volume of the patients in the observation group was significantly higher than that in the control group at 24 hours after treatment, and the difference was statistically significant (P0.05). The improvement rate of dyspnea and the incidence of adverse reactions were not significantly different between the two groups at each time point after treatment (P0.05). Conclusion the combination of RH BNP and levsimentanone can effectively improve the vital signs, hemodynamic and echocardiographic parameters, dyspnea symptoms, increase urine volume and decrease plasma BNP concentration in patients with ADHF.
【作者单位】：枣庄矿业集团枣庄医院内七科;枣庄市立医院心内科;枣庄矿业集团枣庄医院神经内科;
【分类号】：R541.6

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