重组人脑钠肽和硝酸甘油治疗急性左心衰的临床研究

Clinical Study on Recombinant Human Brain Natriuretic Peptide and Nitroglycerin in Treating Acute Left Heart Failure

目的比较重组人脑钠肽和硝酸甘油治疗急性左心衰的临床效果。方法选择2008年5月至2012年3月我院收治的80例急性左心衰的患者作为观察对象,随机分三组,A组(26例)在常规治疗基础上采用硝酸甘油治疗;B组(26例)治疗组采用常规基础上予重组人脑钠肽治疗;C组(28例)采用重组人脑钠肽联合硝酸甘油治疗。观察比较治疗前后三组的临床疗效、心功能各项指标和血压、心率、肾功能及电解质。结果 A组总有效率为69.3%,B组总有效率为84.6%,C组总有效率为100.0%;C组疗效优于A、B两组,B组的总有效率高于A组,但无显著性差异(P>0.05);三组患者治疗后心功能各项指标均较治疗前明显改善(P<0.05),差异具有统计学意义。C组治疗后心功能各项指标改善情况优于A、B两组;治疗后三组患者收缩压、舒张压均较治疗前降低,且C组优于A、B两组,三组患者的心率较治疗前均有改善,且C组优于A、B两组,B组优于A组,三组治疗前后肾功能及电解质均无明显变化。结论重组人脑钠肽联合硝酸甘油治疗能有效地改善急性左心衰的临床症状、体征和心功能指标,拮抗急性左心衰引起的反射性心率增加。

Objective To compare the clinical effect of recombinant human brain natriuretic peptide and nitroglycerin in the treatment of acute left heart failure. Methods Eighty cases of acute left heart failure from May 2008 to March 2012 in our hospital were recruited as observation objects, and were randomly divided into three groups： group A （26 cases） was treated was with conventional therapy and nitroglycerin treatment; group B （26 cases） was treated by routine combined with recombinant human brain natriuretic peptide treatment; group C （28 cases） was treated with recombinant human brain natriuretic peptide combined with nitroglycerin treatment. Clinical curative effect, heart function indexes and blood pressure, heart rate, renal fimction and electrolytes before and after treatment of the three groups were observed and compared. Results The total effective rate was 69.3% in group A, 84.6% in group B, and 100.0% in group C; and curative effect of group C is better than that of A and group B; group B＇s total efficiency is higher than that of group A, but with no significant difference （P 〉0.05）; cardiac function indexes after treatment in the three groups of patients were significantly improved, and were statistically different from those before treatment （P 〈0.05）. After treatment, the improvement of cardiac function indicators in group C is better than that of group A and group B. After treatment, systolic pressure and diastolic pressure of three groups were lower than those before the treatment, and it was better in group C than in group A and group B. Heart rate were improved in three groups after treatment, and it was better in group C than in group A and group B, and better in group B than in group A. Renal function and electrolytes in the three groups did not changed significantly before and after treatment. Conclusions Recombinant human brain natriuretic peptide combined with nitroglycerin in the treatment of acute left heart failure can improve the clinical symptoms, signs and heart function index, and be against the reflection rate increasing caused by antagonistc acute left heart failure.