早期应用新活素与硝普钠治疗急性心力衰竭的对比研究

发布时间：2018-04-19 20:12

本文选题：新活素 + 硝普钠　；参考：《华北理工大学》2016年硕士论文

【摘要】：目的对比早期静脉应用新活素(重组人脑利钠肽,Recombinant human brain natriuretic peptide,rh BNP)或硝普钠治疗急性心力衰竭患者的临床疗效及预后情况。方法连续收集自2014年3月至2015年6月期间唐山市工人医院心内一科收治的急性心力衰竭患者共计294例,随机分为治疗组(147例)与对照组(147例)。治疗组在发病24小时内运用标准化抗心力衰竭治疗方法的同时加用新活素,用微量泵以0.0075μg·kg~(-1)·min~(-1)静脉泵入,维持治疗7天;对照组在在发病24小时内运用标准化抗心力衰竭治疗方法的同时加用硝普钠注射液,首先在闭光条件下用微量泵以2μg·kg~(-1)·min~(-1)静脉泵入,依据症状及血压调整剂量,常用剂量给予3μg·kg~(-1)·min~(-1),极量为10μg·kg~(-1)·min~(-1),持续应用7天。制定严格规范的研究调查表,详细收集记录患者的一般资料、用药前后血液生化指标(氨基末端前B型钠尿肽、电解质、肾功能)、尿量、超声心功能检查指标(LVEF、SV、CI、CO)、血压、住院天数、9个月内心衰再住院率及死亡人数等各项数据。并将相关数据用Excel形式建立数据库,应用SPSS21.0统计软件包进行统计分析。计数资料以百分率(%)表示,两组间比较采用χ2检验分析;计量资料以均数±标准差(sx±)表示,两组间比较采用t检验分析;治疗前后各指标变化幅度以中位数(四分位数间距)[M(P25-P75)]表示,两组间比较采用秩和检验分析,P0.05表示差异具有统计学意义。结果实验组与对照组患者的心功能状况及24小时尿量情况治疗后均较前明显增加,差异有统计学意义(P0.05),并且实验组治疗后的心功能状况、24小时尿量情况以及升高幅度均明显优于对照组,差异有统计学意义(P0.05);实验组与对照组患者的血浆NT-pro BNP水平治疗后均较前明显降低,差异有统计学意义(P0.05),并且实验组治疗后的血浆NT-pro BNP水平以及降低幅度明显优于对照组,差异有统计学意义(P0.05);对照组的血压状况治疗后较前明显降低,差异有统计学意义(P0.05),但实验组治疗后的血压较前差异无统计学意义(P0.05),并且对照组治疗后的血压降低幅度明显大于实验组,差异有统计学意义(P0.05);实验组与对照组的肾功能、电解质水平治疗前后以及变化幅度均无明显不同,差异无统计学意义(P0.05);实验组的住院天数、9个月内心衰再住院次数以及9个月内死亡人数较对照组明显减少,差异有统计学意义(P0.05)。结论1急性心力衰竭患者早期应用新活素能进一步改善患者心功能状况,进一步增加患者24小时尿量,进一步降低患者血浆NT-pro BNP水平,对患者肾功能、电解质无明显影响,并且不会降低患者血压水平;2急性心力衰竭患者早期应用新活素能显著减少急性心力衰竭患者住院天数、9个月内心衰再住院率以及9个月内死亡人数。
[Abstract]:Objective to compare the clinical effect and prognosis of patients with acute heart failure treated with recombinant human brain natriuretic peptide human brain natriuretic peptiderh BNPs or sodium nitroprusside. Methods A total of 294 patients with acute heart failure were collected from March 2014 to June 2015. The patients were randomly divided into treatment group (n = 147) and control group (n = 147). In the treatment group, the treatment group was treated with standardized anti-heart failure therapy within 24 hours and was treated with neovasin and 0.0075 渭 g kg 路kg ~ (-1) 路min ~ (-1) 路min ~ (-1). The treatment was maintained for 7 days. The control group was treated with standardized anti-heart failure therapy and sodium nitroprusside injection within 24 hours after the onset of the disease. First, the control group was injected intravenously with a micropump of 2 渭 g 路kg ~ (-1) 路min ~ (-1) under the condition of closed light. The dosage was adjusted according to the symptoms and blood pressure. The usual dose was 3 渭 g / kg / min ~ (-1) 路min ~ (-1) ~ (-1), and the maximum dose was 10 渭 g / kg ~ (-1) / min ~ (-1) / min ~ (-1) 路min ~ (-1) 路min ~ (-1) 路min ~ (-1) for 7 days. Make a strict and standardized research questionnaire, collect and record the general data of the patients in detail, and collect and record the general data of the patients in detail, and the blood biochemical indexes before and after medication (amino terminal B-type natriuretic peptide, electrolytes, renal function, urine volume, ultrasonic cardiac function index, LVEF / SVVCICOG, blood pressure, blood pressure, etc. Days of hospitalization, rehospitalization rate and death rate of heart failure within 9 months. The database is established in the form of Excel, and the statistical analysis is carried out by SPSS21.0 software package. The counting data were expressed as percentage, 蠂 2 test analysis was used for comparison between the two groups, and the mean 卤standard deviation (sx 卤) was used for the measurement data, and t test analysis was used for the comparison between the two groups. Before and after treatment, the range of changes of each index was the median (quartile spacing) [MU P25-P75], and the difference between the two groups was statistically significant by rank sum test (RSR) analysis (P0.05). Results the cardiac function and 24-hour urine volume of the patients in the experimental group and the control group were significantly increased after treatment. The difference was statistically significant (P 0.05), and the cardiac function of the experimental group was significantly better than that of the control group. The plasma NT-pro BNP level in the experimental group and the control group was significantly lower than that in the control group after treatment, and the difference was statistically significant (P 0.05), and the plasma NT-pro BNP level in the experimental group was significantly higher than that in the control group. The difference was statistically significant (P 0.05), and the blood pressure in the control group was significantly lower than that before treatment. The difference was statistically significant (P 0.05), but there was no significant difference in blood pressure between experimental group and control group after treatment, and the decrease of blood pressure in control group was significantly larger than that in experimental group (P 0.05), and the renal function of experimental group and control group was significantly higher than that of control group. There was no significant difference in electrolyte level before and after treatment, and the difference was not statistically significant (P 0.05). The days of hospitalization, the number of rehospitalization within 9 months and the number of deaths within 9 months in the experimental group were significantly lower than those in the control group. The difference was statistically significant (P 0.05). Conclusion (1) early application of neovasin in patients with acute heart failure can further improve the cardiac function, further increase the 24-hour urine volume, further reduce the plasma NT-pro BNP level, and have no significant effect on renal function and electrolytes in patients with acute heart failure. The early application of neovasin in patients with acute heart failure could significantly reduce the hospitalization days of patients with acute heart failure, the rehospitalization rate of heart failure within 9 months and the number of deaths within 9 months.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.6

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