老年慢性肺源性心脏病急性加重期患者应用新活素与米力农治疗3天后的疗效与安全性对比

Comparison between recombinant human brain natriuretic peptide and milrinone in efficacy and safety after 3 days of treatment for elderly patients with acute exacerbation of chronic pulmonary heart disease

目的比较新活素与米力农在治疗老年慢性肺源性心脏病(CPHD)急性加重期患者疗效与安全性的差异。方法回顾性分析2017年1月至2019年12月天津医院及天津市第三中心医院年龄≥65岁的69例CPHD急性加重期患者的临床资料。按照接受药物治疗不同分为2组,米力农组(40例)和新活素组(29例)。比较2组患者临床疗效,治疗前、治疗后3d心率(HR)、24h尿量、脑钠肽(BNP)、血肌酐(SCr)、肺动脉收缩压(PASP)、左室射血分数(LVEF)变化及不良反应发生情况。采用SPSS 17.0软件对数据进行分析。根据数据类型,组间比较分别采用χ^2检验或t检验。结果治疗后,新活素组总有效情况优于米力农组[27(93.1%)和29(72.5%)],差异有统计学意义(χ^2=4.667,P=0.031)。2组患者治疗后HR、BNP、SCr、PASP较治疗前均有所降低,LVEF、24h尿量较治疗前均明显升高,差异均有统计学意义(均P<0.05);在降低BNP、PASP,提高LVEF、增加尿量方面,新活素组优于米力农组,差异均有统计学意义(均P<0.05)。米力农组患者用药后发生恶心呕吐、室性心律不齐及其他3例(7.5%),新活素组患者发生低血压2例(6.7%),差异无统计学意义(P>0.05)。发生不良反应的患者均经调整药物剂量及对症治疗后好转,无严重不良反应发生。结论新活素和米力农对治疗老年CPHD急性加重期患者均有明显的效果及较好的安全性,新活素比米力农的治疗效果更显著。

Objective To compare recombinant human brain natriuretic peptide(rhBNP)with milrinone in their efficacy and safety in treating the elderly patients with acute exacerbation of chronic pulmonary heart disease(CPHD).Methods Totally 69 CPHD patients were retrospectively collected,who were admitted to Tianjin Hospital and the Third Central Hospital of Tianjin from January 2017 to December 2019,and they were divided into rhBNP group and milrinone group.Efficacy of the treatment was evaluated based on the change of heart rate(HR),24-hour urine volume,brain natriuretic peptide(BNP),serum creatinine(SCr),pulmonary artery systolic pressure(PASP)and left ventricular ejection fraction(LVEF)before and after the treatment.SPSS statistics 17.0 was used for statistical analysis.Data comparison between two groups was perfomed usingχ^2 test or t test depending on data type.Results The overall effective rate was 27(93.1%)in the rhBNP group and 29(72.5%)in the milrinone group with statistically significant difference(χ^2=4.667,P=0.031).After treatment,the HR,BNP,SCr and PASP decreased,and the LVEF and 24-hour urine volume increased in both groups,the differences being statistically significant(all P<0.05).The comparison between two groups showed rhBNP outperformed milrinone in reducing BNP and PASP,improving LVEF,and increasing the 24-hour urine volume with significant differences(P<0.05).Nausea and vomiting,ventricular arrhythmia and other adverse reactions occurred in 3(7.5%)patients in the milrinone group,and hypotension occurred in 2 patients in the rhBNP group,while the difference not being statistically significant(P>0.05).All patients with adverse reactions got improvement after dosage adjustment and symptomatic treatment,and no serious adverse outcomes occurred.Conclusion Both rhBNP and milrinone have obvious efficacy and safety in the elderly CPHD patients with acute exacerbation,and rhBNP is more effective than milrinone.