重组人脑利钠肽治疗急性心肌梗死临床观察

The study on the clinical efficacy and safety of recombinant human B-type natriuretic peptide （rhBNP） in Ireatment of patients with acute myocardial infarction

目的探讨重组人脑利钠肽（rhBNP）治疗急性心肌梗死的临床疗效和安全性。方法80例急性心肌梗死患者随机分为对照组和治疗组。两组均给予WHO规定的标准基础治疗方案（ABCDE）及PEI治疗。治疗组在此基础上加用rhBNP，90s匀速静脉注射冲击量1．5μg/kg，0．0075μg·kg^-1·min^-1维持静脉注射48h；观察治疗前后血浆脑钠利肽（BNP）、心肌坏死标志物（肌钙蛋白I，cTnl）水平变化；利用左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）和射血分数（LVEF）评价左心功能及左室重塑；观察治疗后30d内的主要心血管事件。结果与对照组比较，rhBNP能显著降低心肌梗死后1周血浆BNP及cTnI水平（均P〈0．05）；能显著缩小LVEDV及LVESV，提高LVEF（均P〈0．05）；能降低30d内的主要心血管事件的发生率（P〈0．05）。结论rhBNP能改善心肌梗死后心室压力、容量负荷、心室重构、心肌缺血并减少30d主要心血管事件的发生，改善AMI的临床预后。

Objective To investigate the clinical efficacy and safety of recombinant human B-type natriuretic peptide（rhBNP） in treatreat of patients with acute myocardial infarction （AMI）. Methods 80 patients with AMI were randomly divided into control and treatment group. The two groups were accepted the standard foundation treatment（ABCDE） defined by the WHO and PCI therapy. The treatment group was added the rhBNP on the basis. The rhBNP was uniformly injected by intravenous with 1.5μg/kg in 90s, and then with 0. 0075 μg. k g^- 1 .min^ - 1 in 48h ; To investigate the BNP and myocardiolysis maker（Troponin I.cTnI） levels in blood-serum before and after the treatment;To evaluate left cardiac functions and left ventricular remodeling by left ventricular end-diastolic volume （LV- EDV） ,left ventricular end-systolic volume （LVESV） and left ventricular ejection fraction （LVEF） ; To investigate the major cardiovascular events after treatment within 30 days. Results RhBNP could significantly reduce the concentra- tion of the BNP and cTnl in blood-serum after treating one week （ all P 〈 0.05 ） ; It could remarkably deflate LV EDV and LVESV, improve LVEF （ all P 〈 0.0 5 ） ; It could reduce the incidence of major cardiovascular events （ P 〈 0.0 5 ） within 30 days（P 〈 O. 05）. Conclusion The rhBNP could improve left ventricular pressure-phore and volume-phore, improve ventricular remodeling,improve myocardial ischemia and reduce major eardiovasc,lar events wit}fin 30 days. II was proved that the rhBNP could improve AMI Clinical prognosis.