硝普钠治疗急性心衰伴射血分数保留患者对心功能影响观察

Observation of effects of sodium nitroprusside on cardiac function in patients with acute heart failure with preserved ejection fraction

目的:观察硝普钠在抢救伴射血分数保留的心衰(HFp EF)患者时对心功能的影响。方法:按照血浆脑利钠肽(NT-proBNP)的水平,将93例患者分为高NT-proBNP组(56例)和极高NT-proBNP组(37例)。高NT-proBNP组患者的NT-proBNP≤3 000 pg·ml-1;极高NT-proBNP组患者的NT-proBNP>3 000 pg·ml-1。根据选用药物的不同,高NT-proBNP组患者再分为硝普钠亚组(27例)和对照亚组(29例)。极高NT-proBNP组患者分为硝普钠亚组(18例)和对照亚组(19例)。硝普钠亚组采用硝普钠治疗;对照亚组患者均给予其他药物治疗(包括硝酸甘油,多巴胺,ACEI/ARB类,美托洛尔,螺内酯及中药类改善循环药物)。治疗前和治疗后3 h,比较各组患者的心功能改善情况,包括呼吸频率变化、心率恢复正常时间、血氧饱和度等;检测治疗前和治疗后第5天,各组患者的血浆NT-proBNP变化、住院时间和再住院率。结果:高NT-proBNP组的硝普钠组患者心功能改善的总有效率为92.6%(25/27),高于对照亚组患者的72.4%(21/29),差异有统计学意义(P<0.05);极高NT-proBNP组的硝普钠组患者心功能改善的总有效率为50%(9/18),高于对照亚组患者的26.3%(5/19),差异有统计学意义(P<0.05);与治疗前比较,两组患者的对照亚组和硝普钠亚组患者的血浆NT-proBNP值均明显降低,且在极高NT-proBNP组硝普钠亚组患者的NT-proBNP降低较对照亚组更显著(P<0.05);高NT-proBNP组的硝普钠亚组患者的再住院率为25.6%(7/18)较对照亚组的27.6%(8/19)稍低,但差异无统计学意义(P>0.05);极高NT-proBNP组的硝普钠亚组患者的再住院率为33.3%(6/18)低于对照亚组的57.9%(11/19),差异有统计学意义(P<0.05);两组患者的平均住院时间差异无统计学意义(P>0.05)。结论:硝普钠在AFP伴HFp EF患者中对心功能的改善程度优于常规药物,临床效果尤以极高NT-proBNP组患者明显。

Objective To observe the clinical effects of sodium nitroprusside in emergency treatment of patients with acute heart failure with preserved ejection fraction （HfpEF）. Methods ： 93 patient were randomly divided into high BNP group （n = 5 6 ,NT -proBNP〉3 000 pg · ml^-1 ） and extra high BNP group （n = 37,NT-proBNP〉3 000 pg ·ml^-1 ） according to the level of plasma N - terminal pro-brain natriuretic peptide （NT-proBNP）. Then,the high BNP group was subdivided sodium nitroprusside group （n = 27） and control group （n = 29） based on the treatment of sodium nitroprusside,while the extra high BNP group was also subdivided sodium nitroprusside group （n = 18） and control group （n=19）. All the patients in control groups were treated with others drugs including Ni-troglycerin ,Dopamine,ACEI/ARBs,Metoprolol,Spironolactone,and some traditional Chinese medicines for improving circulation. The improvements of cardiac function （changes of respiration rate,heart rate recovery time,oxygen saturation,etc. ） before and 3h af-ter the treatment of these groups were compared. The levels of plasma NT-proBNP of these groups were measured before and 5 days af-ter the treatment,and their changes were compared. The hospital stay and rehospitalization rate were compared among the subgroups. Results： For high NT-proBNP group,the total efficiencies of the improvement of cardiac function were 92.6% （25/27） in sodium ni-troprusside group and 72.4% （21/29） in control group,respectively,and the difference was statistically significant （P 〈 0 .0 5 ） ; while for extra high NT-proBNP group,the total efficiencies of the improvement of cardiac function were 50% （9/18） in sodium nitroprus-side group and 26.3%（5/19） in control group,respectively,and the difference was statistically significant （P 〈 0 . 0 5 ） . The levels of plasma NT-proBNP of the four subgroups after the treatment were obviously reduced compared with those before the treatment,and the reduction in sodium nitroprusside subgroup in extra high BNP group was more than that in control group （ P 〈 0 . 0 5 ） . For high NT- proBNP group,the rehospitalization rates were 25. 6%（7/18） in sodium nitroprusside group and 27.6% （8/19） in control group,re-spectively ,and the difference was not statistically significant （ P〉0.05） ; while for high NT-proBNP group,the rehospitalization rates were 33. 3% （6/18） in sodium nitroprusside group and 57. 9%（11/19） in control group,respectively,and the difference was statisti-cally significant （P〈0.05）. Further, there was no statistical difference in the hospital stay between the two groups （P〉0.05）. Con-clusions ：Sodium nitroprusside can obviously improve the cardiac function in the patients with acute heart failure with HfpEF than the conventional drugs, and its clinical effects are more significant when in high dose.