新活素治疗急性中高危肺栓塞疗效评价:一项回顾性队列研究

Evaluation of rhBNP in the Treatment of Acute Middle-high Risk Pulmonary Embolism:A Retrospective Cohort Study

目的本研究旨在评估新活素在急性中高危肺栓塞患者中的治疗效果。方法回顾性纳入了2015年6月至2021年6月我院住院确诊急性肺栓塞患者,共90例中高危肺栓塞患者,其中4例失访。根据是否使用新活素,分为新活素组34例和非新活素组52例。对比两组患者的人口学特征、基线资料及治疗情况,并分析对比两组患者血管活性药物使用、机械通气、院内死亡、3个月死亡率、6个月死亡率、9个月死亡率等结局指标。对远期结局指标呼吸困难进行多因素分析,根据近期及远期死亡率绘制K-M生存曲线。结果两组人群人口学特征无差异(P>0.05),但心率、收缩压、cTnI和是否双侧肺栓塞等临床基线资料存在差异(P<0.05)。最后一次随访时,新活素组的呼吸困难症状明显少于非新活素组(P=0.018)。对呼吸困难进行单因素分析发现,使用新活素的OR值为0.31(95%CI 0.12~0.83)(P=0.02)。两组近期和远期生存率无差异(P=0.97)。结论新活素可以改中高危肺栓塞善患者远期呼吸困难症状,提高生活质量,但不降低近期及远期死亡率。

OBJECTIVE This study was aim to evaluate the therapeutic effect of rhBNP in patients with acute medium-high risk pulmonary embolism.METHODS A total of 90 patients with acute pulmonary embolism diagnosed in our hospital from June 2015 to June 2021 were retrospectively included,of which 4 patients were lost to follow-up.According to whether rhBNP was used,there were 34 cases in the rhBNP group and 52 cases in the non-rhBNP group.The demography characteristics,baseline data and treatment of the two groups of patients were compared,and the use of vasoactive drugs,mechanical ventilation,hospital death,3-month mortality,6-month mortality,9-month mortality and other outcome indicators of the two groups of patients were analyzed and compared.A multifactorial analysis on the long-term outcome indicator of dyspnea was performed,and a K-M survival curve based on the recent and long-term mortality rates was ploted.RESULTS There was no difference in demography characteristics between the two groups(P>0.05),but there were differences in the clinical baseline data such as heart rate,systolic blood pressure,cTnI,and whether there was bilateral pulmonary embolism or not(P<0.05).At the last follow-up,the respiratory distress symptoms in the rhBNP group were significantly lower than those in the non-rhBNP group(P=0.018).A univariate analysis of dyspnea revealed that the OR value for the use of rhBNP was 0.31(95%CI 0.12-0.83)(P=0.02).There were no difference in the short-term and long-term survival rates between the two groups(P=0.97).CONCLUSION rhBNP can improve long-term respiratory distress symptoms and improve quality of life in patients with medium-high risk pulmonary embolism,but does not reduce short-term and long-term mortality rates.