左西孟旦联合rhBNP对急性失代偿性心力衰竭患者心功能的影响

Effect of levosimendan combined with recombinant human brain natriuretic peptide on cardiac function in patients with acute decompensated heart failure

目的探讨左西孟旦联合重组人脑利钠肽(rhBNP)对急性失代偿性心力衰竭(ADHF)心功能的影响。方法选择武警陕西省总队医院心内科于2018年1月至2019年6月期间收治的75例ADHF患者为研究对象,根据随机数表法分为A组、B组和C组,每组25例,分别在常规治疗的基础上接受左西孟旦、rhBNP以及左西孟旦联合rhBNP治疗,72 h后评价疗效。比较三组患者治疗前后的心率(HR)、呼吸(R)及尿量的变化,以及血清N末端B型利钠肽原(NT-proBNP)水平、左室射血分数(LVEF)值和左室舒张末期内径(LVEDD)的变化。结果治疗后,三组患者的心率、呼吸频率均明显降低,尿量明显增加,但是C组改善程度明显优于A组、B组,差异均有统计学意义(P<0.05);治疗后,三组患者的收缩压及舒张压无明显变化,差异均无统计学意义(P<0.05);治疗后,C组患者的LVEF、血清NT-proBNP分别为(49.4±4.6)%、(3.21±1.02)×10^3 ng/L,明显优于A组的(45.2±5.8)%、(6.67±1.60)×10^3 ng/L,以及B组的(44.7±4.9)%、(5.95±1.74)×10^3 ng/L,差异均有统计学意义(P<0.05);治疗后,三组患者的LVEDD比较差异无统计学意义(P>0.05)。结论左西孟旦联合rhBNP治疗急性失代偿性心力衰竭可以发挥协同作用,能够有效稳定血流动力学,改善患者的心衰症状,提高患者的心功能。

Objective To investigate the clinical effect of levosimendan combined with recombinant human brain natriuretic peptide(rhBNP)on cardiac function in patients with acute decompensated heart failure(ADHF).Methods Seventy-five patients with ADHF treated in Department of Cardiology,Shaanxi Provincial Corps Hospital from January 2018 to June 2019 were selected as the study objects.According to the random number table method,they were divided into group A(n=25),group B(n=25)and group C(n=25),which were treated with levosimendan,rhBNP,and levosimendan combined with rhBNP respectively on the basis of conventional treatment.The efficacy was evaluated 72 hours later.The changes of heart rate(HR),respiration(R),and urine volume,the levels of serum N-terminal pro-B-type natriuretic peptide(NT proBNP),left ventricular ejection fraction(LVEF),and left ventricular end diastolic diameter(LVEDD)were compared before and after treatment.Results After treatment,the heart rate and respiratory rate of the three groups were significantly reduced,urine volume was significantly increased,but the improvement of group C was significantly better than that of group A and group B(P<0.05).After treatment,there was no significant difference in systolic and diastolic blood pressure among the three groups(P<0.05).After treatment,LVEF and NT proBNP in group C were(49.4±4.6)%and(3.21±1.02)×10^3 ng/L,respectively,which were significantly better than(45.2±5.8)%and(6.67±1.60)×10^3 ng/L of group A(P<0.05).After treatment,there was no significant difference in LVEDD among the three groups(P>0.05).Conclusion Levosimendan combined with rhBNP can play a synergistic role in the treatment of acute decompensated heart failure,which can effectively stabilize hemodynamics,improve the symptoms of heart failure and improve the heart function of patients.