硝普钠、多巴胺、新活素三联用药治疗难治性心力衰竭的临床研究

Clinical study on triple combination of sodium nitroprusside,dopamine and rh-BNP in the treatment of refractory heart failure

目的观察硝普钠、多巴胺、新活素三联用药治疗难治性心力衰竭的临床效果。方法选取难治性心力衰竭患者120例,按照随机数字表法分为A、B、C、D组各30例。4组均行常规抗心力衰竭治疗,A组在常规治疗的基础上联用硝普钠+多巴胺、B组联用新活素+硝普钠、C组联用新活素+多巴胺、D组联用硝普钠+多巴胺+新活素。观察4组治疗7d后临床症状、体征缓解情况,治疗后首个24h尿量,并对比血清B型脑利钠肽(brain natriuretic peptide,BNP)及心脏彩色超声改善情况。结果治疗7d后4组临床疗效和总有效率差异均无统计学意义(P>0.05)。治疗后4组BNP水平均明显低于治疗前,B、C、D组BNP水平低于A组(P<0.05);B、C组BNP水平下降幅度大于A组,C组BNP水平下降幅度小于B组,D组BNP水平下降幅度差值大于A、B、C组(P<0.05)。治疗后4组首个24h尿量均明显大于治疗前,D组首个24h尿量均明显大于A、B、C组(P<0.05);B、C、D组首个24h尿量增加幅度差值大于A组,D组首个24h尿量增加幅度差值大于B、C组(P<0.05)。治疗后4组左心室射血分数(left ventricular ejection fraction,LVEF)与治疗前差异无统计学意义(P>0.05),左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDd)明显低于治疗前(P<0.05);4组LVEF及LVEDd差异均无统计学意义(P>0.05)。B组出现血压偏低2例,其余3组均无不良反应发生。结论硝普钠、多巴胺、新活素三联用药能显著改善难治性心力衰竭患者的临床症状和利尿剂抵抗,降低BNP水平,从而有利于患者康复。

Objective To observe the clinical efficacy of triple combination of sodium nitroprusside,dopamine and rh-BNP in the treatment of refractory heart failure.Methods A total of 120 patients with refractory heart failure who were admitted in our hospital were included in the study and randomized into groups A,B,C,and D with 30 cases in each group.The patients in the four groups were given routine anti-heart failure treatments.On the above basis,the patients in group A were given sodium nitroprusside+dopamine,those in group B were given rh-BNP+sodium nitroprusside,those in group C were given rh-BNP+dopamine,and those in group D were given sodium nitroprusside+dopamine+rh-BNP.After 7-day treatment,the clinical symptoms,signs remission,and the first 24 h urine volume after treatment in the four groups were observed.The serum BNP and cardiac ultrasound improvement were compared.Results The comparison of the clinical efficacy and the total effective rate 7 d after treatment among the four groups was not significantly different(P>0.05).BNP levels after treatment in the four groups were significantly reduced when compared with before treatment(P<0.05).BNP levels in groups B,C,and D were significantly lower than those in group A(P<0.05).The reduced degree of BNP level in groups B and C was significantly greater than that in group A(P<0.05).The reduced degree of BNP level in group C was significantly less than that in group B(P<0.05).And the reduced degree of BNP level in group D was significantly greater than that in groups A,B,and C(P<0.05).The first 24 h urine volume after treatment in the four groups was significantly increased when compared with before treatment(P<0.05).The first 24 h urine volume in group D was significantly higher than that in groups A,B,and C(P<0.05).The increased degree of the first 24 h urine volume in groups B,C,and D was significantly greater than that in group A(P<0.05).The increased degree of the first 24 h urine volume in group D was significantly greater than that in groups B and C(P<0.05).Left ventricular ejection fraction(LVEF)value after treatment in the four groups was not significantly different when compared with before treatment(P>0.05).Left ventricular end-diastolic diameter(LVEDd)after treatment was significantly reduced when compared with before treatment(P<0.05).The comparison of LVEF and LVEDd among the four groups was not statistically significant(P>0.05).In group B,2 cases had hypotension,and no adverse reactions occurred in other 3 groups.Conclusion The triple combination of sodium nitroprusside,dopamine and rh-BNP in the treatment of refractory heart failure can significantly improve the clinical symptoms and diuretic resistance,reduce BNP level,and contribute to the rehabilitation.