参附注射液联合重组人脑利钠肽治疗硝酸盐干预后效果不佳扩张型心肌病的临床研究

Clinical study on Shenfu Injection combined with recombinant human brain natriuretic peptide in treatment of dilated cardiomyopathy with poor nitrate intervention

目的探讨参附注射液联合冻干重组人脑利钠肽治疗硝酸盐干预后效果不佳扩张型心肌病的临床疗效。方法选取天津市第四医院2013年2月—2015年10月收治的硝酸盐干预效果不佳扩张型心肌病患者90例,所有患者按照随机数字表格法分为3组,每组各30例。参附注射液组静脉滴注参附注射液,40 mL加入葡萄糖注射液250 mL中,1次/d。重组人脑利钠肽组给予冻干重组人脑利钠肽,先静脉推注1.5μg/kg,90 s内推注完,随后加以冻干重组人脑利钠肽7.5 ng/(kg·min)持续泵入48 h。联合用药组行参附注射液联合冻干重组人脑利钠肽治疗,其中参附注射液、重组人脑利钠肽治疗方案同上。3组患者均连续治疗10 d。观察3组的临床疗效,同时比较3组治疗前后心功能指标、6 min步行距离、血浆钠尿肽(BNP)和高敏C反应蛋白(hs-CRP)水平。结果 3组总有效率分别为86.7%、83.3%、93.3%,联合用药组总有效率高于其他两组,但是3组总有效率比较差异无统计学意义。治疗后,3组左心室射血分数(LVEF)、6 min步行距离明显升高,左心室舒张末内径(LVEDD)明显缩小,同组治疗前后比较差异具有统计学意义(P<0.05);联合用药组LVEF、6 min步行距离均明显高于参附注射液组和重组人脑利钠肽组,3组比较差异具有统计学意义(P<0.05)。治疗后,3组血浆BNP、hs-CRP水平明显下降,同组治疗前后比较差异具有统计学意义(P<0.05);且联合用药组的这些指标下降幅度明显大于参附注射液组和重组人脑利钠肽组,3组比较差异具有统计学意义(P<0.05)。结论参附注射液联合重组人脑利钠肽治疗硝酸盐干预后效果不佳扩张型心肌病具有较好的临床疗效,能够改善心功能,降低血浆BNP、hs-CRP水平,具有一定的临床推广应用价值。

Objective To investigate the clinical curative effects of Shenfu Injection combined with Lyophilized Recombinant Human Brain Natriuretic Peptide in treatment of dilated cardiomyopathy with poor nitrate intervention. Methods Patients（90 cases） with dilated cardiomyopathy with poor nitrate intervention in the Fourth Hospital of Tianjin from February 2013 to October 2015 were divided into three groups according to the random number table method, and each group had 30 cases. The patients in the Shenfu Injection group were iv administered with Shenfu Injection, 40 mL added intoglucose injection 250 mL, once daily. The patients in the recombinant human brain natriuretic peptide（rh BNP） group were given Lyophilized Recombinant Human Brain Natriuretic Peptide, first intravenous injection 1.5 μg/kg in 90 s, then continuously pumped with dosage of 7.5 ng/（kg·min） for 48 h. The patients in the combined group were treated with Shenfu Injection combined and Lyophilized Recombinant Human Brain Natriuretic Peptide. The patients in three groups were treated for 10 d. After treatment, the clinical efficacies were evaluated, and cardiac function indexes, 6 min walking distance, blood BNP, and hs-CRP in three groups before and after treatment were compared. Results After treatment, the efficacies were 86.7%, 83.3%, and 93.3%, respectively, and the efficacy in the combined group was higher than those in other groups, but there was no significant difference among three groups. After treatment, LVEF and 6 min walking distance in three groups were significantly increased, LVEDD were obviously shortened, blood BNP, and hs-CRP were significantly decreased, and the differences were statistically significant in the same group（P〈 0.05）. After treatment, the observational indexes in the combined group were significantly better than those in the Shenfu Injection and rh BNP groups, with significant difference between two groups（P〈 0.05）. Conclusion Shenfu Injection combined with Lyophilized Recombinant Human Brain Natriuretic Peptide has clinical curative effect in treatment of dilated cardiomyopathy with poor nitrate intervention, can significantly improve cardiac function, and can significantly decrease BNP and hs-CRP levels, which has a certain clinical application value.