左西孟坦联合冻干重组人脑利钠肽对急性心肌梗死合并心力衰竭患者心肌保护作用的临床研究

Protective effects of levosimendan combined with lyophilized recombinant human brain natriuretic peptide on myocardium in patients with acute myocardial infarction complicated by heart failure

目的观察左西孟坦联合冻干重组人脑利钠肽(新活素)用于治疗急性心肌梗死合并心力衰竭的疗效及对患者心肌的保护作用。方法选取长兴县人民医院2018年6月至2020年6月收治的急性心肌梗死合并心力衰竭患者140例为研究对象,采用随机数字表法分为对照组和研究组,每组70例。对照组患者予以常规治疗,研究组患者增加左西孟坦联合新活素治疗。检测两组患者治疗前后血清肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnI)、乳酸脱氢酶(LDH)和超敏C反应蛋白(hs-CRP)等心肌损伤相关指标,统计左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)等心脏超声指标变化情况,评价患者治疗后心力衰竭临床疗效水平,观察治疗期间药物不良反应发生情况。结果研究组患者治疗后CK-MB[(56.73±12.15)U/L]、cTnI[(0.41±0.19)μg/L]、LDH[(126.83±15.26)U/L]和hs-CRP[(1.59±0.27)mg/L]含量均显著低于对照组[(78.52±14.07)U/L、(0.68±0.21)μg/L、(187.25±23.04)U/L、(2.84±0.41)mg/L](t=5.569~12.418,均P<0.05);研究组患者LVEDD和LVESD均显著低于对照组,而LVEF显著高于对照组(t=4.435~6.426,均P<0.05);研究组患者治疗总有效率[88.57%(62/70)]显著高于对照组[72.86%(51/70)](χ^(2)=5.552,P<0.05);研究组治疗期间药物不良反应总发生率[11.43%(8/70)]与对照组[8.57%(6/70)]比较差异无统计学意义(χ^(2)=0.317,P>0.05)。结论左西孟坦联合新活素可有效缓解急性心肌梗死合并心力衰竭患者心肌损伤程度,改善心肌功能,用药安全性较高,值得临床推广使用。

Objective To investigate the protective effects of levosimendan combined with lyophilized recombinant human brain natriuretic peptide(rhBNP)on myocardium in patients with acute myocardial infarction complicated by heart failure.Methods 140 patients with acute myocardial infarction complicated by heart failure who received treatment in Changxing People's Hospital from June 2018 to June 2020 were included in this study.They were randomly assigned to receive either routine treatment(control group,n=70)or routine treatment,levosimendan combined with rhBNP(study group,n=70).Serum levels of creatine kinase(CK)-MB,cardiac troponin I(cTnI),lactate dehydrogenase(LDH),high-sensitivity C-reactive protein(hs-CRP),which were associated with myocardial injury,were measured in each group.In addition,the changes in cardiac ultrasound indexes left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)were observed.Clinical effects on heart failure were evaluated.Adverse drug reactions were monitored during the treatment.Results After treatment,CK-MB,cTnI,LDH and hs-CRP levels in the study group were(56.73±12.15)U/L,(0.41±0.19)μg/L,(126.83±15.26)U/L and(1.59±0.27)mg/L,respectively,which were significantly lower than those in the control group[(78.52±14.07)U/L,(0.68±0.21)μg/L,(187.25±23.04)U/L,(2.84±0.41)mg/L,t=5.569-12.418,all P<0.05].LVEDD and LVESD in the study group were significantly lower than those in the control group,while LVEF in the study group was significantly higher than that in the control group(t=4.435-6.426,all P<0.05).Total effective rate in the study group was significantly higher than that in the control group[88.57%(62/70)vs.72.86%(51/70),χ^(2)=5.552,P<0.05].There was no significant difference in total incidence of adverse drug reactions between study and control groups[11.43%(8/70)vs.8.57%(6/70),χ^(2)=0.317,P>0.05].Conclusion Levosimendan combined with rhBNP can effectively alleviate myocardial injury in patients with acute myocardial infarction complicated by heart failure,improve myocardial function,is highly safe,and thereby deserves clinical application.