重组人脑利钠肽联合伊伐布雷定治疗急性心肌梗死合并心力衰竭患者的临床疗效及安全性

Clinical effect and safety of recombinant human brain natriuretic peptide combined with ivabradine in the treatment of acute myocardial infarction patients complicated with heart failure

目的观察重组人脑利钠肽联合伊伐布雷定治疗急性心肌梗死(AMI)合并心力衰竭患者的临床疗效及安全性。方法选取2018—2019年长沙东协盛医院收治的AMI合并心力衰竭患者76例,根据入院顺序奇偶法分为对照组和观察组,各38例。对照组予以盐酸伊伐布雷定治疗,观察组在对照组基础上予以注射用重组人脑利钠肽治疗,2组均持续治疗1周。比较2组临床疗效,治疗前后心肌损伤标志物[N末端脑钠肽前体(NT-proBNP)、脑钠肽(BNP)、心肌肌钙蛋白I(cTnI)]、心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]及心脏不良事件、不良反应发生率。结果观察组总有效率为97.37%,高于对照组的78.95%(χ^(2)=4.537,P=0.033)。治疗后,2组血清NT-proBNP、BNP、cTnI水平低于治疗前,且观察组低于对照组(P<0.05)。治疗后,2组LVEF高于治疗前,LVEDD、LVESD小于治疗前,且观察组LVEF高于对照组,LVEDD、LVESD小于对照组(P<0.01)。观察组心脏不良事件总发生率为2.63%,低于对照组的21.05%(χ^(2)=4.537,P=0.033)。2组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论重组人脑利钠肽联合伊伐布雷定治疗AMI合并心力衰竭患者的临床疗效确切,可有效改善患者的心功能,减轻心肌损伤,降低心脏不良事件发生率,且安全性较高。

Objective To discuss the clinical effect and safety of recombinant human brain natriuretic peptide combined with ivabradine in the treatment of acute myocardial infarction(AMI)patients complicated with heart failure.Methods A total of 76 cases of AMI patients complicated with heart failure were selected form 2018 to 2019 in Changsha Dongxiesheng Hospital,and they were divided into control group and observation group according to admission order parity method,38 cases in each group.Patients in the control group were given ivabradine,patients in the observation group were given recombinant human brain natriuretic peptide based on control group,both groups were treated with 1 week.Clinical effect,myocardial injury markers(NT-proBNP,BNP,c Tn I),cardiac function indexes(LVEF,LVEDD,LVESD)before and after treatment,and incidence of cardiac adverse events,adverse reactions were compared between the two groups.Results Total effective rate of the observation group was 97.37%,which was higher than 78.95%of the control group(χ^(2)=4.537,P=0.033).After treatment,serum levels of NT-proBNP,BNP,c Tn I in the two groups were lower than those before treatment,and those in the observation group were lower than control group(P<0.05).After treatment,LVEF in the two groups was higher than that before treatment,LVEDD,LVESD were less than those before treatment,and LVEF in the observation group was higher than that of the control group,LVEDD,LVESD were less than those of the control group(P<0.01).Incidence of cardiac adverse events in the observation group was 2.63%,which was lower than 21.05%of the control group(χ^(2)=4.537,P=0.033).There was no significant difference of the incidence of adverse reactions between the two groups(P>0.05).Conclusion Recombinant human brain natriuretic peptide combined with ivabradine have an exact clinical effect in the treatment of AMI patients complicated with heart failure,which can improve cardiac function of patients,reduce myocardial injury nad incidence of cardiac adverse events,and with higher safety.