重组人B型利钠肽治疗慢性心力衰竭急性发作失代偿期的临床疗效观察

Observation on Clinical Efficacy of Recombinant Human Brain Natriuretic Peptide in Treatment of Decompensated Acute Attack of Chronic Heart Failure

目的探讨重组人B型利钠肽(rhBNP)辅助治疗慢性心力衰竭急性发作失代偿期(DAACHF)的临床疗效与安全性。方法将双鸭山煤炭总医院心内科2011年3月至2013年2月收治的68例DAACHF患者根据随机数字表法分为两组:常规治疗组(33例)给予吸氧、强心、利尿、营养心肌等常规抗心力衰竭治疗,联合治疗组(35例)在常规治疗组的基础上联合应用rhBNP,抗心力衰竭治疗7 d后对比两组患者的心功能指标、临床疗效与不良反应发生情况。结果①两组心功能指标均较之治疗前明显改善,联合治疗组左心室舒张末期直径、左心室收缩末期直径、左心室射血分数、左心室短轴缩短率、6 min步行运动耐量指标均显著优于常规治疗组(P<0.05)。②联合治疗组总有效率高于常规治疗组(94.3%vs 78.8%),差异有统计学意义(Z=2.401,P=0.016);联合治疗组平均住院天数显著少于常规治疗组[(14.2±3.2)d vs(17.4±4.4)d](t=3.413,P=0.001)。③联合治疗组出现低血压、头痛等不良反应比例低于常规治疗组(14.7%vs 45.2%),差异有统计学意义(χ2=7.271,P=0.007)。结论在对DAACHF患者常规抗心力衰竭治疗的基础上联合使用rhBNP能显著地改善心肌收缩力,增加心输出量,同时能减缓其他抗心力衰竭药物带来的不良反应。

ObjectiveTo observe clinical efficacy of recombinant human brain natriuretic peptide（rhBNP） in treatment of decompensated acute attack of chronic heart failure（DAACHF）.MethodsA total of 68 patients with DAACHF admitted to the Shuangyashan Coal General Hospital from Mar.2011 to Feb.2013,were randomly divided into combined treatment group（35 cases）,conventional therapy group（33 cases）,the conventional therapy group was treated with oxygen,cardiotonic,diuresis,myocardial nutrition etc.The combined treatment group was given rhBNP based on the conventional treatment.After 7 d anti heart failure treatment,the cardiac function index,clinical efficacy and adverse effects were compared between the two groups.Resultspre-treatment,LVDD,LVEF,LVSF,6 min walking exercise tolerance index of combined treatment group were significantly better than conventional therapy group,the （94.3%） of combined treatment group were higher than conventional therapy group （78.8%）,there was significant differences（Z=2.401,P=0.016）; mean hospital stay （14.2±3.2） d of combined treatment group was significantly less than such as headache and hypotension proportion of combined treatment group were lower than conventional therapy group （14.7% vs 45.2%） （χ^2=7.271,P=0.007）.ConclusionConventional anti heart failure therapy combined with rhBNP can significantly improve myocardial contractility,increased cardiac output,and reduce adverse reaction incidences of other drugs for DAACHF patients.