重组人脑利钠肽联合双水平气道正压通气治疗重症AHF患者的疗效及对心功能、血流动力学及抗氧化指标的影响

Therapeutic effect of recombinant human brain natriuretic peptide combined with dual-level positive airway pressure ventilation on severe AHF patients and its impact on cardiac function,hemodynamics,and antioxidant indicators

目的 研究重组人脑利钠肽联合双水平气道正压通气治疗重症急性心力衰竭(AHF)患者的疗效及对心功能、血流动力学及抗氧化指标的影响。方法 对2020年6月至2022年6月上海市浦东新区人民医院收治的107例重症AHF患者的临床急救资料进行回顾性分析。根据急救方法不同将其分为对照组(n=51)和联合组(n=56)。所有患者均进行强心、利尿、抗感染等常规急救措施,对照组采用双水平气道正压通气,联合组采用双水平气道正压通气联合重组人脑利钠肽治疗。统计分析两组治疗前后的临床疗效、治疗前和治疗72 h后的心功能指标[左室射血分数(LVEF)、左心室收缩末期容积(LVESV)、N末端B型利尿钠肽原(NT-proBNP)]、血流动力学指标[心率、平均动脉压(MAP)、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))]、抗氧化指标[超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)]水平,并记录两组患者的撤机时间及24 h尿量。结果 联合组的临床总有效率为91.07%,明显高于对照组(78.43%),差异有统计学意义(P<0.05)。治疗72 h后,联合组患者LVEF为(55.13±4.45)%,显著高于对照组[(47.96±4.75)%],LVESV、NT-proBNP分别为(53.61±5.45) mL、(1 848.43±209.31) ng/L,均显著低于对照组[(69.14±5.37) mL、(2 731.35±221.57) ng/L],差异均有统计学意义(P<0.05)。治疗72 h后,联合组患者心率及MAP、PaCO_(2)水平分别为(86.75±10.52)次/min、(89.32±1.25) mmHg、(40.24±3.63) mmHg,均显著低于对照组[(98.18±8.65)次/min、(100.74±2.15) mmHg、(48.02±3.97) mmHg],PaO_(2)水平为(69.37±5.07)mmHg,高于对照组[(59.16±5.34) mmHg],差异均有统计学意义(P<0.05)。治疗72 h后,联合组患者SOD、CAT、GSH-Px水平分别为(558.16±54.35)μg/g、(281.07±45.69)μg/g、(55.34±4.14)U/L,均显著高于对照组[(479.67±55.14)μg/g、(229.81±45.62)μg/g、(41.05±4.91) U/L],差异均有统计学意义(P<0.05)。联合组患者撤机时间为(22.31±5.81) h,短于对照组[(29.05±6.63) h],24 h尿量为(1 628.85±138.92) mL,大于对照组[(1 337.95±110.59) mL],差异均有统计学意义(P<0.05)。结论 重组人脑利钠肽联合双水平气道正压通气用于重症AHF衰竭急救临床疗效显著,可有效改善患者心功能、血流动力学及抗氧化指标,对促进钠排泄和缩短撤机时间更为有利。

Objective To study the therapeutic effect of recombinant human brain natriuretic peptide combined with dual-level positive airway pressure ventilation on patients with severe acute heart failure(AHF) and its impact on cardiac function,hemodynamics,and antioxidant indicators.Methods The clinical data of 107 patients with severe AHF admitted to Shanghai Pudong New Area People's Hospital from June 2020 to June 2022 were retrospectively analyzed.According to different emergency methods,they were divided into the control group(n=51) and the combination group(n=56).All patients underwent routine emergency measures such as cardiac strengthening,diuresis,and anti infection.The control group received dual-level positive airway pressure ventilation,while the combination group received dual level positive airway pressure ventilation combined with recombinant human brain natriuretic peptide treatment.The clinical effect,cardiac function indicators [left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),N-terminal pro-B-type natriuretic peptide(NT-proBNP)],hemodynamic indicators [heart rate,mean arterial pressure(MAP),arterial carbon dioxide pressure(PaCO_(2)),and arterial oxygen pressure(PaO_(2))],antioxidant indicators [superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-Px)] of two groups of patients before treatment and after 72 hours of treatment were statistically analyzed,and the extubation time,and 24-hour urine output of two groups of patients were recorded.Results The total clinical effective rate of the combination group was 91.07%,which was significantly higher than that of the control group(78.43%),the difference was statistically significant(P<0.05).After 72 hours of treatment,the LVEF of patients in the combination group was(55.13±4.45)%,which was significantly higher than that of the control group [(47.96±4.75)%],LVESV and NT-proBNP were(53.61±5.45) mL and(1 848.43±209.31) ng/L in the combination group,respectively,which were significantly lower than those of the control group [69.14±5.37) mL and(2 731.35±221.57) ng/L],and the differences were statistically significant(P<0.05).After 72 hours of treatment,the heart rate,the levels of MAP,and PaCO_(2) of patients in the combination group were(86.75±10.52) beats/min,(89.32±1.25) mmHg,and(40.24±3.63) mmHg,respectively,which were significantly lower than those of the control group[(98.18±8.65) times/min,(100.74±2.15) mmHg,(48.02±3.97) mmHg],the level of PaO_(2) was(69.37±5.07) mmHg,which was higher than that in the control group [(59.16±5.34) mmHg],and the differences were statistically significant(P<0.05).After 72 hours of treatment,the levels of SOD,CAT,and GSH-Px of patients in the combination group were(558.16±54.35) μg/g,(281.07±45.69) μg/g and(55.34±4.14) U/L,respectively,which were significantly higher than those in the control group [(479.67±55.14)] μg/g,(229.81±45.62) μg/g,(41.05±4.91) U/L],the differences were statistically significant(P<0.05).The extubation time for patients in the combined group was(22.31±5.81) h,which was shorter than that of the control group [(29.05±6.63) h],and the 24-hour urine output was(1 628.85±138.92) mL,which was greater than that of the control group [(1 337.95±110.59) mL],the difference was statistically significant(P<0.05).Conclusion The combination of recombinant human brain natriuretic peptide and dual-level positive airway pressure ventilation has significant clinical efficacy in emergency treatment of severe AHF failure.It can effectively improve the patient's cardiac function,hemodynamics,and antioxidant indicators,and is more beneficial for promoting sodium excretion and shortening extubation time.