rhBNP治疗AHF的临床疗效及对血流动力学及炎症因子的影响

Clinical efficacy of rhBNP in treating AHF and its effect on hemodynamics and inflammatory factors

目的通过观察急性心力衰竭(AHF)患者治疗前后血流动力学参数、心功能及炎症因子水平变化,探讨重组人脑利钠肽(rhBNP)治疗AHF的临床疗效及安全性。方法将2012年6月至2015年12月聊城市中医医院收治的96例AHF患者分为对照组及观察组各48例,两组均给予常规抗心衰治疗,观察组静脉滴注rhBNP,对照组静脉滴注硝普钠,每组选取15例监测血流动力学变化,观察临床疗效,测定用药前后心率、血压、尿量、心功能指标及血浆N末端脑钠肽前体(NT-proBNP)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)水平变化,观察不良反应发生情况。结果观察组总有效率明显高于对照组(P<0.05),观察组用药后各时间点肺动脉压(PAP)、肺毛细血管压(PCWP)明显低于用药前,两组PAP、PCWP比较差异有统计学意义(P<0.05);用药后两组心率、收缩压、NT-proBNP、IL-6、hs-CRP水平均明显降低,尿量、左室射血分数(LVEF)明显增加,两组比较差异有统计学意义(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论 rhBNP治疗急性心力衰竭短期疗效优于硝普钠,可改善患者血流动力学及心功能,降低炎症因子水平。

Objective To explore the clinical efficacy and safety of recombinant human brain natriuretic peptide （rhBNP） in the treatment of acute heart failure（AHF） by observing the changes of hemodynamic parameters,cardiac function and inflammatory factors before and after treatment in the patients with AHF. Methods A total of 96 patients with AHF in our hospital from June 2012 to December 2015 were enrolled in this study and divided into the control group and observation group（n= 48）. The two groups were given the routine anti-heart failure treatment combined with sodium nitroprusside or rhBNP by intravenous dripping for 24 h. Fifteen cases were selected from each group for monitoring the hemodynamic change. The clinical effect was observed. The changes of heart rate, blood pressure, urine volume, cardiac function, plasma of NT-proBNP, IL- 6 and hs CRP before and after medication were observed. The occurrence of adverse reactions was also observed. Results The total effective rate of the observation group was significantly higher than that in the control group （P〈0.05）. The PAP and PCWP at various time points after treatment in the observation group were significantly lower than those before treatment （P〈0.05）. PAP and PCWP at various time points had statistical difference between two groups （P〈0.05）. The levels of heart rate, systolic blood pressure, NT-proBNP, IL 6 and hs- CRP levels after medication were significantly decreased in both groups, and the urine volume and LVEF were significantly increased （P〈0. 05） ,and the difference between the two groups was statistically significant（P〈0.05）. There was no statistically significant difference in the occurrence of adverse reactions between the two groups （P〉0.05）. Conclusion The short term efficacy of rhBNP in treating AHF is better than sodium nitroprusside, which can improve hemodynamics and cardiac function, reduces the level of inflammatory factors.