重组人脑利钠肽对脓毒症合并心肾综合征患者的治疗作用

Therapeutic effect of recombinant human brain natriuretic peptide on patients with sepsis and cardiorenal syndrome

目的:探讨重组人脑利钠肽(rhBNP)对脓毒症合并心肾综合征患者的治疗效果及安全性。方法:以我院2017-03—2019-05期间的86例脓毒症合并心肾综合征患者为研究对象,随机分为对照组(43例)和观察组(43例);对照组给予抗感染、心肾功能不全等治疗,观察组在对照组基础上另给予rhBNP治疗;对比2组心、肾功能、血浆及预后指标。结果:治疗4周后,观察组心脏指数(CI)[(4.23±1.25)L/min·m^2]、左室射血分数(LVEF)[(39.18±5.54)%]明显高于对照组[(3.74±0.92)L/min·m^2,(35.34±5.67)%],观察组外周血管阻力指数(SVRI)[(1847.36±172.59)dyn·s/(cm^5·m^2)]明显低于对照组[(2102.27±183.38)dyn·s/(cm^5·m^2)](均P<0.05)。治疗4周后,观察组血肌酐(Scr)[(103.24±22.18)μmol/L]、BUN[(8.63±1.47)μmol/L]明显低于对照组[(143.66±24.57)μmol/L,(11.58±1.96)μmol/L],观察组肾小球滤过率(GFR)[(44.26±5.71)mL/min)]明显高于对照组[(38.84±5.56)mL/min)](均P<0.05)。治疗4周后,观察组血浆氨基末端B型利钠肽前体(NT-proBNP)[(3516.14±947.23)ng/L)]、降钙素原(PCT)[(0.06±0.02)ng/mL)]、Lac[(0.92±0.25)mmol/L]明显低于对照组[(3972.23±916.24)ng/L,(2.32±1.94)ng/mL,(1.45±0.31)mmol/L](均P<0.05)。观察组ICU住院时间[(11.3±1.5)d]明显低于对照组[(14.2±1.6)d](P<0.05);观察组4周病死率(39.53%)低于对照组(58.14%),但差异无统计学意义(P>0.05)。结论:rhBNP能够促进脓毒症合并心肾综合征患者心肾功能指标恢复,并降低患者脓毒症状,改善患者预后,值得在临床中推广应用。

Objective:To investigate the therapeutic effect and safety of recombinant human brain natriuretic peptide in patients with sepsis and cardiorenal syndrome.Method:From March 2017 to May 2019 in our hospital,86 patients with sepsis and cardiorenal syndrome were randomly divided into the control group(43 cases)and the observation group(43 cases).Treatments for cardiac and renal insufficiency were given in control group,and the observation group was given rhBNP treatment on the basis of the control group;the heart,kidney function,plasma and prognostic indicators of the two groups were compared.Result:After 4 weeks of treatment,the CI[(4.23±1.25)L/min·m^2]and LVEF[(39.18±5.54)%]in the observation group were significantly higher than those in the control group[(3.74±0.92)L/min·m^2,(35.34±5.67)%],and the SVRI in the observation group[(1847.36±172.59)dyn·s/(cm^5·m^2)]was significantly lower than that in the control group[(2102.27±183.38)dyn·s/(cm^5·m^2)](all P<0.05).After 4 weeks of treatment,Scr[(103.24±22.18)μmol/L]and BUN[(8.63±1.47)μmol/L]in the observation group were significantly lower than those in the control group[(143.66±24.57)μmol/L,(11.58±1.96)μmol/L],and GFR in the observation group[(44.26±5.71)mL/min)]was significantly higher than that in the control group[(38.84±5.56)mL/min)](all P<0.05).After 4 weeks of treatment,NT-proBNP[(3516.14±947.23)ng/L)],PCT[(0.06±0.02)ng/mL)],and Lac[(0.92±0.25)mmol/L]were significantly lower in the observation group than those in the control group[(3972.23±916.24)ng/L,(2.32±1.94)ng/mL,(1.45±0.31)mmol/L](all P<0.05).The number of days of ICU stay in the observation group[(11.3±1.5)d]was significantly lower than that in the control group[(14.2±1.6)d](P<0.05);the 4-week mortality rate(39.53%)in the observation group was lower than that in the control group(58.14%),but the difference was not obvious(P>0.05).Conclusion:rhBNP can promote the recovery of heart and kidney function indexes in patients with sepsis and cardiorenal syndrome,and reduce the sepsis symptoms and improve the prognosis of patients.It is worthy of popularization and application in clinical.