硝普钠和多巴胺联合冻干重组人脑利钠肽对难治性心力衰竭患者的影响

Impact of Sodium Nitroprusside and Dopamine Combined with Lyophilized Recombinant Human Brain Natriuretic Peptide on Patients with Refractory Heart Failure

目的探讨硝普钠和多巴胺联合冻干重组人脑利钠肽对难治性心力衰竭(RHF)患者的影响。方法选取2014年6月—2016年6月张家口市第一医院心内三科收治的RHF患者120例,采用随机数字表法分为A组、B组、C组、D组,每组30例。在常规抗心力衰竭治疗基础上,A组患者给予硝普钠联合多巴胺治疗,B组患者给予硝普钠联合冻干重组人脑利钠肽治疗,C组患者给予多巴胺联合冻干重组人脑利钠肽治疗,D组患者给予硝普钠和多巴胺联合冻干重组人脑利钠肽治疗;4组患者均连续治疗7 d。比较4组患者临床疗效,治疗前后B型利钠肽差值(ΔBNP)、左心室射血分数差值(ΔLVEF)、左心室舒张末期内径差值(ΔLVEDD),观察4组患者治疗期间不良反应发生情况。结果 4组患者临床疗效比较,差异无统计学意义(P>0.05)。D组患者ΔBNP高于A组、B组、C组(P<0.05),而4组患者ΔLVEF、ΔLVEDD比较,差异无统计学意义(P>0.05)。治疗期间B组患者出现血压偏低2例。结论与硝普钠联合多巴胺、硝普钠联合冻干重组人脑利钠肽、多巴胺联合冻干重组人脑利钠肽相比,在常规抗心力衰竭治疗基础上加用硝普钠和多巴胺联合冻干重组人脑利钠肽可更有效地降低RHF患者血清BNP水平,且安全性较高。

Objective To investigate the impact of sodium nitroprusside and dopamine combined with lyophilized recombinant human brain natriuretic peptide（rh-BNP） on patients with refractory heart failure. Methods From June 2014 to June 2016, a total of 120 patients with refractory heart failure were selected in the Third Department of Cardiology, the First Hospital of Zhangjiakou, and they were divided into A group, B group, C group and D group according to random number table, each of 30 cases. Based on conventional anti-heart failure therapy, patients in A group received sodium nitroprusside combined with dopamine, patients in B group received sodium nitroprusside combined with lyophilized rh-BNP, patients in C group received dopamine combined with lyophilized rh-BNP, while patients in D group received sodium nitroprusside and dopamine combined with lyophilized rh-BNP; all of the four groups continuously treated for 7 days. Clinical effect, BNP difference value（ΔBNP）, LVEF difference value（ΔLVEF）, LVEDD difference value（ΔLVEDD） before and after treatment were compared in the four groups, and incidence of adverse reactions during treatment was observed. Results No statistically significant differences of clinical effect was found in the four groups（P〉0.05）. No statistically significant differences of ΔLVEF or ΔLVEDD was found in the four groups（P〉0.05）, while ΔBNP in D group was statistically significantly higher than that in A group, B group and C group, respectively（P〈0.05）. Only 2 cases in B group occurred blood pressure reduction during treatment. Conclusion Compared with sodium nitroprusside combined with dopamine, sodium nitroprusside combined with lyophilized rh-BNP, dopamine combined with lyophilized rh-BNP, sodium nitroprusside and dopamine combined with lyophilized rh-BNP based on conventional anti-heart failure therapy can more effectively reduce the serum BNP level in patients with refractory heart failure, and is relatively safe.