重组人脑利钠肽在心力衰竭合并呼吸衰竭患者中的疗效观察

Therapeutic effects of recombinant human brain natriuretic peptide on heart failure complicated by respiratory failure

目的探讨重组人脑利钠肽(rh-BNP)治疗心力衰竭合并呼吸衰竭的临床疗效。方法将80例急性失代偿性心力衰竭和急性心肌梗死后心力衰竭伴动脉血氧分压<60 mm Hg的患者,随机分为观察组和对照组,每组40例。2组根据病情给予利尿剂、血管紧张素转化酶抑制剂(ACEI)、醛固酮受体阻滞剂、扩血管药、β受体阻滞剂及无创呼吸机等治疗。观察组在此基础上给予rh-BNP治疗。治疗72 h后,比较2组临床疗效,评测指标包括左心室射血分数(LVEF)、N末端B型利钠肽原(NT-proBNP)、24 h尿量等。结果治疗后观察组总有效率87.5%,对照组总有效率70.0%,2组比较差异有统计学意义(P<0.05)。治疗后2组患者NT-proBNP较治疗前明显降低,LVEF值、24 h尿量均较治疗前明显升高,差异有统计学意义(P<0.01);治疗后观察组与对照组比较,NT-proBNP水平明显下降,LVEF值明显增高、24 h尿量明显增加,差异有统计学意义(P<0.05)。住院期间低血压、心律失常、血肌酐增高的发生率与对照组比较差异无统计学意义(P>0.05)。结论在治疗急性失代偿性心力衰竭和急性心肌梗死后引起动脉血氧分压<60 mm Hg的心力衰竭患者中,应用重组人脑利钠肽可以明显改善患者的临床症状及相关的评测指标,安全性好,适宜推广使用。

Objective To investigate the clinical efficacy of recombinant human brain natriuretic peptide（ rh-BNP）in treatment of heart failure（ HF） complicated by respiratory failure（ RF）. Methods A total of 80 patients with acute decompensated heart failure（ ADHF） or with HF after acute myocardial infarction（ AMI） and arterial oxygen pressure 60 mm Hg were randomly divided into observation group and control group,with 40 cases in each group. The patients in both groups were treated by diuretics,angiotensin converting enzyme inhibitors（ ACEI）,aldosterone receptor blockers,vasodilators,beta-blockers,and non-invasive ventilators according to the disease condition. On this basis,the patients in observation group were given rh-BNP. The clinical efficacy of the two groups was compared after 72-hour treatment,and the evaluation indexes included left ventricular ejection fraction（ LVEF）, N-terminal pro-B-type natriuretic peptide（ NTproBNP）,and 24-h urine volume. Results After treatment,the total effective rates in observation group and control group were 87. 5% and 70. 0%,respectively,there were significant differences between the two groups（ P〈0. 05）. After treatment,NT-proBNP was significantly decreased in both groups,whereas the LVEF value and 24-hour urine volume were significantly increased,as compared with those before treatment（ P〈0. 01）. After treatment,NT-proBNP levels in observation group were significantly lower than those in control group,whereas LVEF values and 24-hour urine volume in observation group were significantly higher than those in control group（ P〈0. 05）. In addition there were no significant differences in the incidence rates of hypotension,arrhythmia,and increased serum creatinine during hospitalization between two groups（ P〈0. 05）. Conclusion In treatment of ADHF patients and HF patients with arterial oxygen pressure 60 mm Hg caused by AMI,rh-BNP can significantly improve the patient ＇s clinical symptoms and related evaluation indexes,with higher safety. Thus,it is worthy of clinical promotion.