新活素联合左西孟旦注射液配合常规血管活性药物治疗难治性心力衰竭40例临床观察

Clinical observation of 40 patients with refractory heart failure treated with Lrh-BNP and levosimendan injection combined with conventional vasoactive drugs

目的观察新活素联合左西孟旦注射液配合常规血管活性药物治疗难治性心力衰竭的临床疗效。方法采用计算机排列法将80例难治性心力衰竭患者随机分为对照组和治疗组,各40例。对照组予常规血管活性药物治疗,治疗组在对照组治疗方法的基础上予新活素联合左西孟旦注射液治疗。治疗完成后,比较2组治疗前后的心功能指标[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、B型钠尿肽前体(Pro-BNP)]水平,并记录2组治疗过程中不良反应发生情况,比较2组不良反应总发生率。结果治疗后2组血清CK、CK-MB、LDH、Pro-BNP水平明显降低,与同组治疗前比较差异均有统计学意义(P<0.01),且治疗组降低更明显,与对照组治疗后比较差异均有统计学意义(P<0.01);对照组不良反应总发生率为12.5%(5/40),治疗组为10.0%(4/40),2组比较差异无统计学意义(P>0.05)。结论新活素联合左西孟旦注射液配合常规血管活性药物治疗难治性心力衰竭疗效显著,能有效改善患者的心功能,且不良反应可控,安全性较高,值得临床推广应用。

Objective To observe the clinical efficacy of lyophilized recombinant human brain natriuretic peptide(Lrh-BNP)and levosimendan injection combined with conventional vasoactive drugs in the treatment of refractory heart failure.Methods 80 patients with refractory heart failure were randomly divided into a control group and a treatment group by computer permutation method,with 40 cases in each.The control group was treated with conventional vasoactive drugs,while the treatment group was administered Lrh-BNP in combination with levosimendan injection on the basis of the treatment approach of the control group.After treatment,the levels of cardiac function indices[creatine kinase(CK),creatine kinase isoenzyme-MB(CK-MB),lactate dehydrogenase(LDH),B-type natriuretic peptide precursor(Pro-BNP)]before and after treatment were compared between the two groups.The occurrence of adverse reactions during treatment was recorded for both groups,and the total incidence of adverse reactions was compared between the two groups.Results The serum levels of CK,CK-MB,LDH,and Pro-BNP in both groups were significantly reduced after treatment,and the differences were statistically significant compared with those before treatment(P<0.01).The reduction was more pronounced in the treatment group,and the differences were statistically significant compared with the control group after treatment(P<0.01).The total incidence of adverse reactions was 12.5%(5/40)in the control group and 10.0%(4/40)in the treatment group,and there was no statistical significance between the two groups(P>0.05).Conclusion The combination of Lrh-BNP with levosimendan injection and conventional vasoactive drugs is effective in the treatment of refractory heart failure,and it can effectively improve the cardiac function of patients with manageable side effects and high safety,which is worthy of clinical promotion and application.