冻干重组人脑利钠肽治疗顽固性心力衰竭合并肺动脉高压患者的短期疗效观察

Short-term efficacy of freeze-dried recombinant human brain natriuretic peptide in the treatment of refractory heart failure complicated with pulmonary hypertension

目的探讨冻干重组人脑利钠肽对顽固性心力衰竭(RHF)合并肺动脉高压(PAH)患者的近期疗效。方法选取2015年9月—2017年3月在潍坊市人民医院心内一科监护室接受抗心衰合并PAH治疗的65例患者,按照治疗方案分为观察组(n=35)和对照组(n=30)。对照组常规抗心衰治疗,观察组在常规治疗基础上应用冻干重组人脑利钠肽(rh BNP)治疗。记录两组患者的临床基线资料、治疗前后呼吸困难改善情况、心功能指标[包括左室射血分数(LVEF)、左室舒张末期内径(LVEDd)及肺动脉收缩压(PASP)和全血氨基末端脑钠肽前体(NT-pro BNP)]及治疗后第1、2、3天24 h尿量情况。结果观察组和对照组一般临床资料差异无统计学意义(P>0.05)。呼吸困难改善情况:观察组治疗总有效率80.00%(28/35)高于对照组的50.00%(15/30)(χ~2=6.49,P=0.01)。24 h尿量情况两组间比较和同组治疗前后比较,均差异有统计学意义(P<0.05);心功能指标,观察组LVEF治疗后较治疗前明显增加,LVEDd及PASP明显降低,与对照组比较差异有统计学意义(P<0.05);各组患者治疗前后NT-pro BNP峰值浓度比较差异有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05);两组不良反应总发生率(14.29%vs 23.33%),差异无统计学意义(P>0.05)。结论冻干重组人脑利钠肽能改善RHF合并PAH患者的呼吸困难症状,提高射血分数,降低肺动脉高压,延缓心室重构,增加心衰患者的24 h尿量,值得在临床治疗RHF合并PAH患者中的应用。

Objective To explore the efficacy of recombinant form of human brain natriuretic peptide(rhBNP)in patients who had refractory heart failure with pulmonary arterial hypertension.Methods65cases patients who had refractory heart failure with pulmonary arterial hypertension accepted anti-heart failure and pulmonary hypertension treatment in September2015to March2017of one Department of Cardiology in Weifang People′s Hospital was selected.According to the treatment program,they were divided into observation group(n=35)and control group(n=30).The clinical baseline data of the two groups contains the improvement of respiratory difficulties before and after treatment,cardiac function indicator,including Left ventricular ejection fraction(LVEF),Left ventricular end diastolic diameter(LVEDd),Pulmonary artery systolic pressure(PASP)and24hours′urine volume of the first,second,third day after treatment were recorded.Results There was no significant difference in general information between the observation group and the control group(P>0.05).There was significant difference between the two groups in the improvement of the dyspnea and the24-hour urine output(P<0.05).On the cardiac function indicator,the difference of LVEDd and PASP were significantly lower while the LVEF was higher in the observation group than that in the control group(P<0.05)with was statistically significant difference(P<0.05).There was significant difference in the peak concentration of NT-proBNP in the two groups before and after treatment(P<0.05),but there was no significant difference between the two groups(P>0.05).The total incidence of adverse reactions in the two groups(14.29%vs23.33%),the difference was not statistically significant(P>0.05).Conclusions Freeze-dried recombinant human brain natriuretic peptide can effectively improve the symptoms of dyspnea in patients with refractory heart failure and pulmonary hypertension,improve ejection fraction,reduce pulmonary hypertension,delay ventricular remodeling and increase the24-hour urine output.Freeze-dried recombinant natriuretic peptide can be used to treat those patients who have refractory heart failure with pulmonary hypertension.