冻干重组人脑利钠肽对急性心肌梗死合并心力衰竭患者NT-proBNP及心功能的影响

Influence of lyophilized recombinant human brain natriuretic peptide on NT-proBNP and cardiac function of AMI patients complicated with HF

目的观察冻干重组人脑利钠肽在合并心力衰竭（HF）的急性心肌梗死（AMI）患者中的临床疗效。方法 77例AMI合并急性HF患者随机分为治疗组37例和对照组40例。2组均给予常规治疗,治疗组在此基础上加用冻干重组人脑利钠肽,先给予1.5μg/kg的负荷量,继之以0.01μg/（kg·min）静脉泵入24~48 h。对照组在常规治疗基础上,加用多巴胺及硝普钠。2组均治疗3 d。结果治疗组有效率91.89%,高于对照组有效率75.00%（P〈0.05）。2组治疗后心率、收缩压、舒张压及氨基前端脑钠肽（NT-pro BNP）水平较治疗前下降,且治疗组均低于对照组,差异有统计学意义（P〈0.01）。2组治疗后每搏输出量（SV）、左室射血分数（LVEF）、心输出量（CO）及心脏指数（CI）较治疗前显著改善,治疗组各指标均高于对照组,差异有统计学意义（P〈0.05或P〈0.01）。治疗组和对照组各发生2例（5.40%）、1例（2.5%）低血压。结论在常规治疗基础上加用冻干重组人脑利钠肽治疗AMI合并HF患者,可有效改善心率、血压,降低NT-pro BNP及CRP水平,改善心功能,值得临床推广。

Objective To observe the clinical efficacy of lyophilized recombinant human brain natriuretic peptide on treatment of patients with acute myocardial infarction（ AMI） and heart failure（ HF）. Methods A total of 77 patients with AMI complicated with HF were randomly divided into treatment group（ 37 cases） and control group（ 40 cases）. Both groups were treated with routine therapies,on which basis,reatment group was added with lyophilized recombinant human brain natriuretic peptide,1. 5 μg / kg load leveling initially and then intravenous pump of 0. 01 μg /（ kg·min）for 24 ~ 48 h,whereas control group was added with dopamine and sodium nitroprusside（ SNP）. Both groups were treated for 3 d. Results The effective rate was 91. 89% in treatment group,evidently higher than the 75. 00% in control group（ P〈0. 05）. After treatment,heart rate（ HR）,systolic blood pressure（ SBP）,diastolic blood pressure（ DBP） and amino front-end brain natriuretic peptide（ NT-pro BNP） decreased markedly than treatment before in both groups,which were apparently lower in treatment group than in control group（ P〈0. 01）. Stroke volume（ SV）,left ventricular ejection fraction（ LVEF）,cardiac output（ CO） and cardiac index（ CI） were improved prominently after treatment than treatment before in both groups,which were apparently higher in treatment group than in control group（ P〈0. 05 or P〈0. 01）. And in treatment and control groups,there were 2（ 5. 40%）and 1（ 2. 5%） hypotension,respectively. Conclusion Application of lyophilized recombinant human brain natriuretic peptide on the basis of routine therapies can effectually improve the heart rate and blood pressure,reduce NT-pro BNP and CRP levels,and promote cardiac function of patients with AMI complicated with HF,thus deserving to be widely used in clinic.