冻干重组人脑利钠肽在老年顽固性心力衰竭患者中的临床应用及护理干预

Clinical application of lyophilized recombinant human brain natriuretic peptide in elderly patients with refractory heart failure and nursing intervention

目的观察冻干重组人脑利钠肽治疗老年顽固性心力衰竭的临床疗效及护理干预的作用。方法选取21例确诊为顽固性心力衰竭的老年患者，在标准化治疗基础上加用冻干重组人脑利钠肽治疗，负荷剂量1．5μg/kg静脉推注，随后按维持剂量0．0075μg/（kg·min）进行静脉滴注，持续24～72h。采用治疗前后自身对照，观察用药前后血压、心率、尿量、呼吸困难程度、下肢水肿情况、纽约心脏病协会（NYHA）心功能是否改善以及血B型脑利钠肽（BNP）浓度，中心静脉压（CVP）监测的变化。并对患者进行护理干预。结果与治疗前比较，治疗后患者血压、心率、血BNP及CVP测定值均明显下降[（128±15）mmHg（1mmHg=0．133kPa）比（144±17）mmHg，（84±9）次／min比（102±13）次／min，（560±180）μg／L比（14501±430）μg／L，（9．2±2．3）mmHg比（14．9±3．6）mmHg]，差异均有统计学意义（均P〈0．05）。治疗后患者心功能Ⅱ级12例，Ⅲ级6例，Ⅳ级3例。治疗后显效7例，有效11例，无效2例，死亡1例。治疗前后NYHA分级比较，差异有统计学意义（P〈0．05）。结论顽固性心力衰竭患者病情进行性加重，冻干重组人脑利钠肽治疗有效，精心的护理对患者康复至关重要。

Objective To observe the efficacy of lyophilized recombinant human brain natriuretic peptide （BNP） and nursing intervention on intractable heart failure in aged subjects. Methods Totally 21 senile intractable heart failure subjects were recruited and treated with lyophilized recombinant human BNP based on new standardized therapy in this self-control trial. Before and after medication, blood pressure, heart rate, urine volume, dyspnea, lower extremities edema, serum BNP concentration and central venous pressure （CVP） were monitored. The patients were given nursing intervention. Results Compared with before treatment, after treatment, the patient＇s blood pressure, heart rate, blood BNP and CVP measured values were significantly decreased [ （ 128 ± 15 ） mm Hg（ 1 mm Hg =0. 133 kPa） vs（ 144 ± 17） mm Hg, （84 ±9）times/rain vs（ 102 ±13）times/rain, （560 ± 180） μg/L vs （ 14501 ±430）μg/L, （9.2 ± 2.3 ） mm Hg vs （ 14.9 ± 3.6 ）mm Hg ], the differences were statistically significant （all P 〈0.05）. After treatment, 12 patients had heart function II. Before and after treatment NHYA classification showed statistically significant differences （P 〈 0. 05）. Conclusion Correct and effective drug and nursing is critical treatment of intractable heart failure exacerbation.