重组人脑利钠肽联合参附注射液治疗急性心肌梗死伴急性心力衰竭的疗效评价

Effect of recombinant human brain natriuretic peptide combined with Shenfu injection in the treatment of acute myocardial infarction complicated with acute heart failure

目的:评价重组人脑利钠肽(rhBNP)和参附注射液联合治疗急性心肌梗死(AMI)伴急性心力衰竭(AHF)病人的有效性和安全性。方法:将符合AMI伴AHF诊断标准并排除心源性休克的病人随机分为rhBNP治疗组(rhBNP组)和rhBNP联合参附注射液治疗组(联合组),各31例。比较2组治疗前后血压、心率、尿量、呼吸困难程度、神经内分泌激素水平和超声心动图指标的变化及临床终点事件、不良反应发生率。结果:与rhBNP组比较,联合组舒张压和心率下降程度差异无统计学意义(P>0.05);治疗期间每24 h的尿量均增多明显(P<0.01);明显改善呼吸困难(P<0.01);神经内分泌激素的水平明显下降(P<0.01)。用药后6个月,联合组LVEF明显升高(P<0.01);LVEDD有轻度减小(P<0.05)。与rhBNP组比较,联合组低血压的发生率较低(P<0.05);在保证收缩压130~90 mmHg及舒张压80~60 mmHg的情况下,2组病人均未出现肾功能不全或原有肾功能不全加重。结论:rhBNP能有效抑制AMI伴AHF病人的神经内分泌激素的激活,改善血流动力学;rhBNP联合参附注射液治疗更有利于改善呼吸困难的程度,控制心衰,更有助于左心室收缩功能的恢复。

Objective: To evaluate the efficacy and safety of the recombinant human brain natriuretic peptide( rhBNP) combined with Shenfu injection in treating acute myocardial infarction( AMI) complicated with acute heart failure( AHF). Methods: Sixty-two patients with AMI complicated with AHF were randomly divided into the rhBNP treatment group and rhBNP combined with Shenfu injection treatment group( combination group)( 31 cases each group). The blood pressre,heart rate,24 hours urine output,dyspnea grade,plasma concentration of neuroendocrine hormone,ultrasonic cardiography parameters and incidence rate of adverse reaction between two groups before and after treatment were compared. Results: Compared with the rhBNP group,the differences of the diastolic pressure decreasing degree were not statistically significant( P > 0. 05),the 24 hours urine output increasing was obvious( P < 0. 01),the dyspnea improvement was significant( P < 0. 01),and the neuroendocrine hormone decreasing was obvious in combination group( P < 0. 01). After 6 months of treatment,the left ventricular ejection fraction significnatly increased( P < 0. 01),and the left ventricular end-diastolic dimension slightly decreased( P < 0. 05). Compared with the rhBNP group,the incidence rate of hypotension in combination group was lower( P < 0. 05). Under the SBP for 130 to 90 mmHg and DBP for 80 to 60 mmHg,no renal insufficiency or renal insufficiency aggravating in two groups was found. Conclusions: The rhBNP can effectively inhibit the activation of neuroendocrine hormone,and improve hemodynamics in patients with AMI complicated with AHF. The rhBNP combined with Shenfu injection can effectively improve the dyspnea,control heart failure,and promote the recovery left ventricular ejection fraction in patients with AMI complicated with AHF.