冻干重组人脑利钠肽联合脑啡肽酶抑制剂治疗急性失代偿性心力衰竭的临床疗效及预后分析

Clinical Efficacy and Prognosis of Lyophilized Recombinant Human Brain Natriuretic Peptide Combined with Enkephalin Inhibitor in Patients with Acute Decompensated Heart Failure

目的探讨冻干重组人脑利钠肽联合脑啡肽酶抑制剂治疗急性失代偿性心力衰竭患者的临床疗效及预后效果。方法收集本院2019年4月至2021年4月收治的101例急性失代偿性心力衰竭患者的临床资料,根据入院血流动力学稳定后早期用药治疗差异分为观察组(冻干重组人脑利钠肽联合脑啡肽酶抑制剂,n=52)和对照组(常规治疗,n=49)。比较两组患者临床疗效、心功能[左室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左房收缩末期内径(left atrium end-systolic diameter,LAESD)、左心室射血分数(left ventricular ejection fraction,LVEF)]、C-反应蛋白(C-reactive protein,CRP)、N末端脑钠肽前体(N-terminal brain natriuretic peptide precursor,NT-proBNP)、24 h尿量、不良反应、住院期间死亡率及预后。结果观察组总有效率(94.23%)明显高于对照组(79.59%)(P<0.05);与治疗前相比,两组治疗后LVEDD、LAESD水平均下降、LVEF水平均上升,其中以观察组最为显著(P<0.05);与治疗前相比,两组治疗后CRP、NT-proBNP水平均下降、24 h尿量均上升,其中以观察组最为显著(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05);观察组住院期间死亡率(1.92%)明显低于对照组(12.24%)(P<0.05);观察组治疗1个月后再入院率(11.54%)低于对照组(28.57%)(P<0.05)。结论急性失代偿性心力衰竭采用冻干重组人脑利钠肽联合脑啡肽酶抑制剂治疗效果显著,有利于改善患者心功能、临床症状以及预后,且具有一定的安全性,临床值得进一步研究推广。

Objective To investigate the clinical efficacy and prognostic effect of lyophilized recombinant human brain natriuretic peptide combined with enkephalin inhibitor in the treatment of patients with acute decompensated heart failure.Methods The clinical data of 101 patients with acute decompensated heart failure admitted to our hospital from April 2019 to April 2021 were collected,and according to the difference of early medication and treatment after admission hemodynamically stable,they were divided into treatment group(lyophilized recombinant human brain natriuretic peptide combined with neprilysin inhibitor,n=52)and control group(conventional treatment,n=49).The clinical efficacy,cardiac function[left ventricular enddiastolic diameter(LVEDD),left atrium end-systolic diameter(LAESD),and left ventricular ejection fraction(LVEF)],C-reactive protein(CRP),N-terminal brain Natriuretic peptide precursor(NT-probNP),24h urine volume,adverse reactions,in-hospital mortality and prognosis were compared between the two groups.Results The total effective rate of treatment group(94.23%)was significantly higher than that of control group(79.59%)(P<0.05);compared with before treatment,the levels of LVEDD and LAESD in the both groups decreased and the level of LVEF increased after treatment,among which the treatment group was the most significant(P<0.05);compared with before treatment,CRP and NT-probNP levels were decreased and 24h urine volume was increased in both groups after treatment,among which the treatment group was the most significant(P<0.05);there was no significant difference in the incidence of adverse reactions between two groups(P>0.05);the in-hospital mortality of treatment group(1.92%)was significantly lower than that of the control group(12.24%)(P<0.05);the readmission rate of treatment group(11.54%)was lower than that of control group(28.57%)after one month treatment(P<0.05).Conclusion The combination of lyophilized recombinant human brain natriuretic peptide and enkephalinase inhibitor is effective in treating acute decompensated heart failure,which is beneficial to improve cardiac function,clinical symptoms and prognosis of patients,and has certain safety,which is worthy of further study and promotion.