重组人脑利钠肽对急性有机磷农药中毒患者心功能的影响

Effects of recombinant human brain natriuretic peptide on heart function caused by acute organophosphorus pesticide poisoning

目的探讨重组人脑利钠钛对急性有机磷农药中毒（AOPP）所致心功能不全患者心功能的影响。方法31例有机磷农药中毒性休克患者随机分为对照组16例和治疗组15例，对照组给予常规治疗＋多巴酚丁胺强心治疗，治疗组给予常规治疗＋多巴酚丁胺及重组人脑利钠肽强心、利尿治疗。观察两组患者治疗开始前及治疗后12、24、48 h左心室射血分数（LVEF）、左心室舒张末期内径（LV）、肌钙蛋白I（CTnI）浓度、尿量及机械通气时间和病死率。结果①两组治疗前LVEF、LV、CTnI及尿量比较差异均未见统计学意义（P均〉0.05）。治疗后，治疗组较对照组各时间点LVEF均增大，LV均减少，尿量均增加，差异有统计学意义（P〈0.05）；治疗组治疗后12 h CTnI浓度与对照组比较差异未见统计学意义（P〉0.05），而两组治疗后24、48 h CTnI浓度比较差异有统计学意义（P〈0.05）。②治疗组较对照组机械通气时间缩短[（3.8±1.0）d比（6.4±1.4）d，P〈0.05]，病死率下降（13.3%比31.3%）。结论重组人脑利钠肽能够改善急性有机磷农药中毒所致的心功能，缩短机械通气治疗时间，降低病死率，改善患者预后。

Objective To study the effects of recombinant human brain natriuretic peptide on cardiac function in patients with cardiac dysfunction caused by acute organophosphorus pesticide poisoning （AOPP）.Methods Thirty-one cases of shocked patients caused by organophosphorus pesticide poisoning were selected and divided into control group （16 cases） and study group （15 cases）. Patients in control group were given conventional treatment ＋ dobutamine cardiac; patients in treatment group were treated with conventional therapy ＋ dobutamine and recombinant human brain natriuretic peptide, cardiac diuretic. The left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter （LV）, troponin I （CTnI） concentration, urine volume, time of mechanical ventilation and fatality rate in the two groups were observed before treatment and at 12 h, 24 h, 48 h after treatment.Results ①There was no significant difference in LVEF, LV, CTnI and urine volume before treatment between the two groups （P〉0.05）. Compared with control group, LVEF increased, LV decreased, urine volume increased in study group at each time point after treatment, the differences were statistically significant （all P〈0.05）; there was no signifcant difference in CTnI concentration 12 h after treatment between study group and control group （P〉0.05）, and at 24 and 48 h after treatment, the difference was statistically significant （P〈0.05）. ②Compared with control group, the duration of mechanical ventilation in study group was shorter [（3.8±1.0） d vs. （6.4±1.4） d, P〈0.05], and the fatality rate decreased （13.3% vs.31.3%）.Conclusions Recombinant human brain natriuretic peptide can improve the cardiac function caused by acute organophosphorus pesticide poisoning, shorten mechanical ventilation treatment time, reduce fatality rate and improve the prognosis of patients.