重组人脑利钠肽联合无创正压机械通气对重症心力衰竭患者的临床治疗效果

Clinical efficacy of recombinant human brain natriuretic peptide combined with non-invasive positive pressure mechanical ventilation in patients with severe heart failure

目的探讨重组人脑利钠肽联合无创正压机械通气治疗对心内科重症监护室(coronary care unit,CCU)重症心力衰竭患者的临床疗效。方法回顾性分析2020年7月至2023年2月CCU重症心力衰竭患者159例,剔除资料不完整34例患者,125例患者纳入研究,按照治疗方案分为对照组61例(常规治疗+无创正压机械通气)和观察组64例(常规治疗+无创正压机械通气+重组人脑利钠肽)。对比两组临床疗效、心血管疾病指标[内皮缩血管肽-1(endothelin-1,ET-1)、半乳糖苷凝集素3(Gal-3)水平、脑钠肽(brain natriuretic peptide,BNP)]、心功能指标[左心室收缩末期容积(left ventricular end-systolic volume,LVESV)、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左心室射血分数(left ventricular ejection fraction,LVEF)]、血气分析指标[动脉血氧分压(arterial oxygen partial pressure,PaO_(2))、动脉血二氧化碳分压(arterial carbon dioxide partial pressure,PaCO_(2))]、氧化应激[丙二醛(malondialdehyde,MDA)、血清胆碱酯酶(cholinesterase,CHE)和超氧化物歧化酶(superoxide dismutase,SOD)]、生活质量及步行能力[Spitzer生活质量指数(Spitzer Quality of Life Index,SQLI)、6min步行试验、堪萨斯城心肌病问卷(Kansas City Cardiomyopathy Questionnaire,KCCQ)]、不良反应及围手术期指标及不良心脏事件。结果对照组与观察组相比较,观察组总有效率更高(92.19%vs.81.97%,P<0.05)。两组治疗后ET-1、Gal-3水平、BNP均降低,且观察组下降幅度大于对照组(P<0.05)。治疗后,观察组LVESV、LVEDV比对照组低,LVEF比对照组高(P<0.05)。两组治疗后PaO_(2)、PaCO_(2)分别升高、降低,且观察组PaO_(2)、PaCO_(2)分别高于、低于对照组(P<0.05)。观察组治疗后CHE、SOD水平高于对照组,MDA水平低于对照组(P<0.05)。观察组治疗后SQLI评分、KCCQ评分比对照组高,6min步行试验比对照组长(P<0.05)。两组不良发应发生率对比差异无统计学意义(P>0.05)。观察组CCU住院时间比对照组短,不良心脏事件总发生率比对照组低(P<0.05)。结论接受无创正压机械通气+重组人脑利钠肽治疗的CCU缺血性心肌病和扩张性心肌病重症心力衰竭患者疗效更佳,可有效缓解临床病症,改善患者ET-1及Gal-3水平和心功能状况。

Objective To investigate the clinical efficacy of recombinant human brain natriuretic peptide(rhBNP)combined with non-invasive positive pressure ventilation(NIPPV)in treating patients with severe heart failure in the coronary care unit(CCU).Methods A retrospective analysis was performed on 159 patients with severe heart failure admitted to the CCU from July 2020 to February 2023.After excluding 34 patients with incomplete data,125 patients were included in the study.They were divided into a control group(61 patients,receiving standard treatment+NIPPV)and an observation group(64 patients,receiving standard treatment+NIPPV+rhBNP).Clinical efficacy,cardiovascular disease indicators[endothelin-1(ET-1),galectin-3(Gal-3),brain natriuretic peptide(BNP)],cardiac function indicators[left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF)],blood gas analysis[arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2))],oxidative stress[malondialdehyde(MDA),serum cholinesterase(CHE),and superoxide dismutase(SOD)],quality of life and walking ability[Spitzer Quality of Life Index(SQLI),6-minute walk test,Kansas City Cardiomyopathy Questionnaire(KCCQ)],adverse reactions,and perioperative indicators were compared between groups.Results The total effective rate in the observation group was significantly higher than in the control group(P<0.05).Levels of ET-1,Gal-3,and BNP decreased in both groups,with a greater reduction in the observation group(P<0.05).The observation group had lower LVESV and LVEDV,and higher LVEF compared to the control group(P<0.05).After treatment,PaO_(2) increased and PaCO_(2) decreased in both groups,with the observation group showing higher PaO_(2) and lower PaCO_(2)(P<0.05).CHE and SOD levels were higher in the observation group,while MDA levels were lower(P<0.05).Quality of life scores(SQLI and KCCQ)and the 6-minute walk test results were better in the observation group(P<0.05).The incidence of adverse reactions was similar between the two groups(P>0.05).The observation group had a shorter CCU hospital stay and a lower overall incidence of adverse cardiac events(P<0.05).Conclusion The combination of NIPPV and recombinant human brain natriuretic peptide provides better clinical outcomes for patients with ischemic cardiomyopathy and dilated cardiomyopathy in severe heart failure,effectively alleviating symptoms,improving ET-1 and Gal-3 levels,and enhancing cardiac function.