冻干重组人脑利钠肽联合参脉注射液对慢性肺源性心脏合并心力衰竭患者的临床疗效

Clinical efficacy of lyophilized recombinant human brain natriuretic peptide combined with Shenmai injection in patients with chronic pulmonary heart disease and heart failure

目的观察冻干重组人脑利钠肽联合参脉注射液治疗慢性肺源性心脏病合并心力衰竭患者的临床疗效。方法采用前瞻性研究,选择2019年5月至2021年5月在儋州市人民医院就诊的60例慢性肺源性心脏病合并心力衰竭患者,按照随机数字表将其分为3组,每组20例。A组给予以常规疗法,B组在常规疗法的基础上使用冻干重组人脑利钠肽,C组在B组疗法的基础上联合参脉注射液治疗。观察3组患者临床疗效、血清和肽素、N端脑钠肽前体(NT-proBNP)和D-二聚体、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、心功能[右心室舒张末期内径(RVEDD)、左室射血分数(LVEF)、肺动脉压]水平以及不良反应。结果3组总体临床疗效比较,差异有统计学意义(P<0.05),其中C组临床疗效优于A组。与治疗前相比较,治疗后,3组血清和肽素、NT-proBNP、D-二聚体、PaCO_(2)、肺动脉压、RVEDD水平均降低,PaO_(2)、LVEF升高,差异均有统计学意义(P<0.05);治疗后,C组血清和肽素、NT-proBNP、D-二聚体、PaCO_(2)、肺动脉压、RVEDD水平为(569.41±367.31)ng/mL、(1011.43±132.71)ng/L、(442.07±129.01)g/L、(45.16±9.41)mmHg、(25.07±5.29)mmHg、(23.13±3.17)mm,均显著低于A组[(896.32±436.04)ng/mL、(1896.32±136.04)ng/L、(652.03±187.32)g/L、(57.19±8.06)mmHg、(29.03±5.87)mmHg、(28.33±3.05)mm]和B组[(701.19±421.67)ng/mL、(1531.09±132.44)ng/L、(543.14±156.31)g/L、(51.25±8.38)mmHg、(28.14±5.56)mmHg、(26.31±3.11)mm],C组PaO_(2)、LVEF为(75.16±8.43)mmHg、(67.13±6.43)%,均明显高于A组[(60.79±8.36)mmHg、(50.36±6.38)%]和B组[(65.31±8.27)mmHg、(55.47±6.22)%],差异均有统计学意义(P<0.05)。3组不良反应发生率比较,差异无统计学意义(P>0.05)。结论冻干重组人脑利钠肽联合参脉注射液治疗慢性肺源性心脏病合并心力衰竭,可显著改善患者心功能,降低血清和肽素、NT-proBNP、D-二聚体水平,临床疗效显著。

Objective To observe the therapeutic effect of freeze-drying recombinant human brain natriuretic peptide combined with Shenmai injection for patients with chronic pulmonary heart disease complicated with heart failure.Methods A total of 60 patients with chronic pulmonary heart disease complicated with heart failure who were treated in Danzhou People's Hospital from May 2019 to May 2021 were selected.They were divided into 3 groups according to the random number table,with 20 cases in each group.Group A was given conventional therapy,group B was given freeze-dried recombinant human brain natriuretic peptide on the basis of conventional therapy,and group C was given Shenmai injection based on the therapy of group B.The clinical efficacy,serum Copeptin,N-terminal pro-brain natriuretic peptide(NT-proBNP)and D-dimer levels,arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),heart function[right ventricular end diastolic diameter(RVEDD),left ventricular ejection fraction(LVEF),pulmonary arterial pressure],and adverse reactions of patients in the three groups were observed.Results There was a statistically significant difference in the overall clinical efficacy of the three groups(P<0.05),and the clinical efficacy of group C was better than that of group A.Compared with before treatment,serum Copeptin,NT-proBNP,D-dimer,PaCO_(2),pulmonary artery pressure and RVEDD levels in the three groups decreased after treatment,and PaO_(2) and LVEF increased,the differences were statistically significant(P<0.05);after treatment,the levels of serum Copeptin,NT-proBNP,D-dimer,PaCO_(2),pulmonary artery pressure and RVEDD in group C were(569.41±367.31)ng/mL,(1011.43±132.71)ng/L,(442.07±129.01)g/L,(45.16±9.41)mmHg,(25.07±5.29)mmHg,(23.13±3.17)mm,which were significantly lower than those in group A[(896.32±436.04)ng/mL,(1896.32±136.04)ng/L,(652.03±187.32)g/L,(57.19±8.06)mmHg,(29.03±5.87)mmHg,(28.33±3.05)mm]and group B[(701.19±421.67)ng/mL,(1531.09±132.44)ng/L,(543.14±156.31)g/L,(51.25±8.38)mmHg,(28.14±5.56)mmHg,(26.31±3.11)mm],PaO_(2) and LVEF in group C were(75.16±8.43)mmHg,(67.13±6.43)%,which were significantly higher than those in group A[(60.79±8.36)mmHg,(50.36±6.38)%]and group B[(65.31±8.27)mmHg,(55.47±6.22)%],the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Lyophilized recombinant human brain natriuretic peptide combined with Shenmai injection in the treatment of chronic pulmonary heart disease with heart failure can significantly improve the heart function of patients and reduce the levels of serum Copeptin,NT-proBNP and D-dimer.The clinical effect is significant.