参麦注射液联合环磷腺苷和重组人脑利钠肽治疗慢性肺源性心脏病心力衰竭的临床研究

Clinical study on Shenmai Injection combined with adenosine cyclphosphate and recombinant human brain natriuretic peptide in treatment of chronic pulmonary heart disease with heart failure

目的探讨参麦注射液联合注射用环磷腺苷和注射用重组人脑利钠肽治疗慢性肺源性心脏病心力衰竭的临床疗效。方法选取2015年10月—2016年10月上海交通大学附属胸科医院收治的慢性肺源性心脏病心力衰竭患者112例,将所有患者随机分为对照组和治疗组,每组各56例。对照组静脉滴注注射用环磷腺苷,40 mg加入到5%葡萄糖注射液或生理盐水100 mL中,1次/d,连续治疗3周。且静脉滴注注射用重组人脑利钠肽,首次负荷剂量1.5μg/kg,之后剂量为7.5 ng/(kg·min),连续治疗3 d。治疗组在对照组基础上静脉滴注参麦注射液,50 mL加入到5%葡萄糖注射液或生理盐水250 mL中,1次/d,连续治疗3周。观察两组的临床疗效,比较两组的血清D-二聚体(D-D)、N末端B型钠尿肽原(NT-proBNP)、心肌肌钙蛋白I(CTI)、血流动力学和动脉血气指标情况。结果治疗后,对照组和治疗组的总有效率分别为78.6%、94.6%,两组比较差异有统计学意义(P<0.05)。治疗后,两组D-D、NT-proBNP和CTnI水平均显著下降,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组右房压(RAP)、右室压(RVP)、平均肺动脉压(mPAP)和二氧化碳分压(pCO_2)均显著下降,而氧分压(pO_2)显著升高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。结论参麦注射液联合注射用环磷腺苷和注射用重组人脑利钠肽治疗慢性肺源性心脏病心力衰竭具有较好的临床疗效,能降低肺动脉高压,改善心肺功能,具有一定的临床推广应用价值。

Objective To investigate the effects of Shenmai Injection combined with Adenosine Cyclphosphate for injection and Recombinant Human Brain Natriuretic Peptide for injection in treatment of chronic pulmonary heart disease with heart failure. Methods Patients（112 cases） with chronic pulmonary heart disease with heart failure in Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University from October 2015 to October 2016 were randomly divided into control and treatment groups, and each group had 56 cases. Patients in the control group were iv administered with Adenosine Cyclphosphate for injection, 40 mg added into 5% glucose solution（or normal saline） 100 mL, once daily and treated for 3 weeks. And patients in the control group were also iv administered with Recombinant Human Brain Natriuretic Peptide for injection, first load dose of 1.5 μg/kg, then dose of 7.5 μg/（kg·min）, continuous treatment for 3 d. Patients in the treatment group were iv administered with Shenmai Injection on the basis of the control group, 50 mL added into 5% glucose solution（or normal saline） 250 mL, once daily and treated for 3 weeks. After treatment, the clinical efficacies were evaluated, and D-dimer（D-D）, NT-proBNP, CTnI, hemodynamics, and arterial blood gas indexes in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 78.6% and 94.6%, respectively, and there was difference between two groups（P〈0.05）. After treatment, the levels of D-D, NT-proBNP, and CTnI in two groups were significantly decreased, and the difference was statistically significant in the same group（P〈0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P〈0.05）. After treatment, RAR, RVP, mPAP, and pCO2 in two groups were significantly decreased, but the pO2 in two groups were significantly increased, and the difference was statistically significant in the same group（P〈0.05）. And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups（P〈0.05）. Conclusion Shenmai Injection combined with Adenosine Cyclphosphate for injection and Recombinant Human Brain Natriuretic Peptide for injection has clinical curative effect in treatment of chronic pulmonary heart disease with heart failure, can decrease high pressure in the pulmonary artery, and improve heart and lung function, which has a certain clinical application value.