新活素联合小剂量速尿治疗急性心肌梗死合并心力衰竭疗效评价

Evaluation of Recombinant Human Brain Natriuretic Peptide Combined with Low Dose Furosemide in the Acute Myocardial Infarction Complicating Heart Failure Therapy

目的观察新活素（rh BNP）联合小剂量速尿治疗急性心肌梗死合并心力衰竭的疗效。方法 50例急性心肌梗死伴心力衰竭患者随机分为治疗组（24例）和对照组（26例）,治疗组在对照组基础上加rh BNP（0.5 mg·支-1,1.5μg·kg-1负荷剂量静脉推注3~5 min,然后以0.01μg·min-1·kg-1的速度持续滴注72 h,对照组予40 mg·d-1速尿静脉注射、病因治疗、扩血管等对症治疗,观察2组患者治疗前后相关心功能指标、血清脑利钠肽（BNP）、超敏C反应蛋白（hs-CRP）浓度的变化。结果治疗前后2组患者左心室舒张末期内径（LVDd）变化差异无统计学意义,治疗组LVEF明显升高（P〈0.05）,2组血浆BNP、血清hs-CRP水平均有下降（P〈0.05）,且治疗组较对照组改善更优（P〈0.05）。结论 rh BNP联合小剂量速尿疗效明显优于速尿一般治疗,能有效改善急性心肌梗死合并心力衰竭患者症状,减少利尿剂抵抗。

OBJECTIVE To observe the effect of recombinant human brain natriuretic peptide（rh BNP） combined with low dose furosemide in the acute myocardial infarction complicating heart failure therapy. METHODS 50 cases of patients of acute myocardial infarction with heart failure were randomly divided into rh BNP treatment group（24 cases） and control group（26 cases）. Rh BNP treatment group were given rh BNP（0.5 mg） loading dose 1.5 μg·kg-1 within 3-5 min based on the control group treatment, and then intravenously given at a speed of 0.01 μg·min-1·kg-1 within 72 h continuously, control group were given 40 mg furosemide intravenously, etiologies and vasodilator therapy and other symptomatic treatment every day. Observed the cardiac function index, serum brain natriuretic peptide（BNP）, hypersensitive c-reactive protein（hs-CRP） concentration changes of the two groups before and after treatment. RESULTS Both two groups before and after treatment the left ventricular end diastolic diameter（LVDd） had no significant changes, and the LVEF in rh BNP treatment group obviously increased（P〈0.05）, the two groups’ plasma BNP, hs-CRP serum levels decreased（P〈0.05）, and the rh BNP treatment group improved better than the control group（P〈0.05）. CONCLUSION The effect of rh BNP combined with little dose furosemide treatment is obviously better than furosemide general treatment, which can effectively improve the symptoms of patients with acute myocardial infarction complicated with heart failure, and can also reduce diuretic resistance.