重组人脑利钠肽联合参附注射液治疗急性心肌梗死并心力衰竭的近期疗效和安全性观察

Short-term therapeutic effects and safety on the combined treatment for acute myocardial infarction and heart failure with recombinant human brain natriuretic peptide and shenfu injection

目的研究分析重组人脑利钠肽联合参附注射液治疗急性心肌梗死并心力衰竭的近期疗效和安全性观察。方法将2014年5月至2015年9月收治的116例急性心肌梗死合并心力衰竭的患者按照随机数字表法分为对照组和观察组,每组58例,对照组患者使用重组人脑利钠肽进行治疗,观察组使用重组人脑利钠肽联合参附注射液进行治疗,比较患者术前术后基本情况,心肌标志物,激素水平变化,测量术后患者心脏超声相关指标,记录终末事件等。结果对照组在用药24 h后血压下降程度更显著于观察组(P<0.05)。呼吸困难评分方面,从24 h之后,观察组评分明显高于对照组(P<0.05)。两组尿量对比,观察组明显多于对照组(P<0.05)。两组患者血肌酐在服药24 h均有下降趋势,但是持续到48 h之后,观察组下降程度明显高于对照组(P<0.05)。两组患者治疗后NE、R、ET、NT-pro MNP、NT-pro MNP均显著下降,(P<0.05),且观察组治疗后各项指标显著低于对照组(P<0.05)。观察组用药后6个月LVEDD和LVEF与对照组比较差异有统计学意义(P<0.05)。结论使用重组人脑利钠肽联合参附注射液治疗急性心肌梗死并心力衰竭,短期内相比单用重组人脑利钠肽效果更佳,更有效改善患者各项生理指标,安全有效,值得医务工作者借鉴和进一步临床研究与推广。

Objective To study the short-term therapeutic effects and safety on the combined treatment for acute myocardial infarction and heart failure with recombinant human brain natriuretic peptide and shenfu injection. Methods From May 2014 to September 2015,116 patients of acute myocardial infarction and heart failure were divided into a control group and an observation group according to random number table,58 cases in each one. In the control group,the recombinant human brain natriuretic peptide was used.In the observation group,the recombinant human brain natriuretic peptide and shenfu injection were used in combination. The basic information,cardiac markers and hormonal readiness were compared before and after treatment. The cardiac ultrasound indicators were measured after operation and the ending events were recorded. Results In 24 h after medication,the blood pressure was reduced more significantly in the control group as compared with the observation group（P〈0. 05）. Regarding dyspnea score,after 24 h,the score in the observation group was higher remarkably than the control group（P〈0. 05）. In comparison of the urine volume,the result in the observation group was higher remarkably than the control group（P〈0. 05）. The serum creatinine value was reduced in tendency in 24 h of medication in the two groups. But after 48 h,the reducing degree in the observation group was higher remarkably than the control group（P〈0. 05）. After treatment,the levels of NE,R,ET and NT-pro MNP were all reduced significantly after treatment in the two groups（P〈0. 05）. After treatment,every indicator in the observation group was lower significantly than thecontrol group（P〈0. 05）. The differences were significant in LVEDD and LVEF in the observation group as compared with the control group in 6 months after medication（P〈0. 05）. Conclusion The combined medication of the recombinant human brain natriuretic peptide and shenfu injection achieves the better short-term effects on acute myocardial infarction and heart failure as compared with the simple use of recombinant human brain natriuretic peptide. This combined medication more effectively improves every physiological indicator and safe in application. This therapy provides the reference to the medical staffs and deserves a further clinical study and application.