酒石酸美托洛尔联合冻干重组人脑利钠肽治疗急性心力衰竭的临床观察

Clinical Efficacy of Metoprolol Tartrate Combined with Lrh-BNP on Acute Heart Failure

目的:观察酒石酸美托洛尔联合冻干重组人脑利钠肽治疗急性心力衰竭的临床疗效和安全性。方法:62例急性心力衰竭患者按随机数字表法分为对照组(32例)和观察组(30例)。对照组患者给予常规抗心力衰竭药物(扩血管药、利尿药、血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体阻滞药、抗血小板药、调脂药等)治疗;观察组患者在对照组治疗的基础上给予酒石酸美托洛尔6.25 mg,bid,并以冻干重组人脑利钠肽0.5 mg加入0.9%氯化钠注射液50 ml中,首次负荷剂量1.5μg/kg静脉注射后,以0.01μg/(kg·min)速度持续72 h静脉泵入。两组患者均治疗72 h后观察临床疗效,治疗前、治疗后24 h及1周后临床症状、心功能指标变化、血压、24 h尿量、实验室指标、再入院率、病死率及不良反应发生情况。结果:观察组患者总有效率显著高于对照组,差异有统计学意义(P<0.05)。治疗前两组患者的临床症状、24 h尿量、实验室指标、N末端前脑利钠肽前体(NT-proBNP)、心功能比较,差异均无统计学意义(P>0.05);治疗后两组患者的血氧饱和度、24 h尿量、射血分数均显著高于同组治疗前,且观察组显著高于对照组,而心率、丙氨酸氨基转移酶、呼吸频率、NT-proBNP、左室舒张末内径均显著低于同组治疗前,且观察组显著低于对照组,差异均有统计学意义(P<0.05)。两组患者的收缩压、血钾、血肌酐治疗前后比较,差异均无统计学意义(P>0.05)。两组患者不良反应发生率、再入院率、病死率比较,差异均无统计学意义(P>0.05)。结论:酒石酸美托洛尔联合冻干重组人脑利钠肽治疗急性心力衰竭疗效显著,安全性较好。

OBJECTIVE： To observe the clinical efficacy and safety of metoprolol tartrate combined with recombinant human brain natriuretic peptide （Lrh-BNP） on acute heart failure. METHODS： A total of 62 patients with acute heart failure were random- ly divided into control group （32 cases） and treatment group （30 cases）. Control group was given routine treatment of drugs against heart failure （blood vessel dilatation medicine, diuretic, angiotensin converting enzyme inhibitors or ARB Ⅱ , antiplatelet drug, lipid drug, etc.）. Observation group was given metoprolol tartrate （AstraZeneca） 6.25 mg, twice a day and Lrh-BNP （China Medical System Holding Ltd.） 0.5 mg added into 0.9% Sodium chloride injection 50 ml with initial dose of 1.5μg/kg via intravenous injection, maintaining for 0.01 gg/（kg.min）. Therapeutic efficacies of 2 groups were observed after 72 h treatment. The clinical symptoms, heart function, blood pressure, 24 h urine, biochemical index, readmission rate, mortality and ADR were observed in 2 groups before and after treatment. RESULTS： The total effective rate of observation group was significantly higher than that of control group; there was statistical significance （P〈0.05）. Clinical symptoms, 24h urine, biochemical index, NT-proBNP and heart function were compared between 2 groups before and after treatment; there was no statistical significance （P〉0.05）. The oxygen saturation of blood, 24 h urine, EF of 2 groups after treatment were significantly higher than before; those of observation group were higher than control group. Heart rate, AAT, breathing rate, NT-proBNP and LVEDD of 2 groups after treatment were significantly lower than before; those of observation group was lower than control group; there was statistical significance （P〈 0.05）. There were no statistical significance in systolic pressure, serum potassium and serum creatinine between 2 groups before and after treatment （P〉0.05）. There were no statistical significance in the incidence of ADR, readmission rate and mortality between 2 groups （P〉0.05）. CONCLUSIONS： The recombinant human brain natriuretic peptideand can improve clinical symptoms, left ventricular remodeling, reduce the NT - proBNP and adverse reactions.