CAJ | 학술논문

目的：观察重组人脑钠肽（rhBNP）治疗急性心力衰竭或慢性心力衰竭急性发作患者的临床疗效。方法纳入65例急性或慢性心力衰竭急性发作患者，随机分为观察组（n=33）和对照组（n=32）。在常规抗心衰治疗的基础（利尿剂、血管紧张素转换酶抑制剂、β受体阻滞剂等）上，观察组给予rhBNP治疗，首先静脉推注负荷剂量1.5μg/kg，随后以0.0075μg/（kg.min）维持静脉泵注48 h；对照组患者给予静脉泵入硝酸甘油治疗，起始剂量5～10μg/min，根据血压情况每次增加5～10μg，直至临床效应平均用量20μg/min，静脉泵入48h。观察两组患者的治疗效果及左室射血分数（LVEF）、血清N端脑钠肽前体（NT-proBNP）、肺动脉压（PAP）、心率、呼吸、住院时间、死亡率、3个月后6分钟步行距离及再住院率情况。结果观察组和对照组患者的总有效率分别为96.9%、68.8%，差异有统计学意义（P＜0.05）。治疗前两组患者LVEF、血清NT-proBNP浓度及心率、呼吸频率、肺动脉压，无显著统计学差异（P＞0.05）。治疗48h后，观察组患者LVEF增加，血清NT-proBNP浓度心率、呼吸频率及肺动脉压降低，治疗前后有统计学差异（P＜0.05）。而对照组患者上述指标在治疗前后比较，无统计学差异（P＞0.05）。与对照组患者相比，观察组患者住院时间明显缩短、住院死亡率降低、3个月后6分钟步行距离增加并且再住院率降低，差异均有统计学意义（P＜0.05）。结论早期应用rhBNP治疗急性心力衰竭或慢性心力衰竭急性发作，能更好的改善患者的症状及愈后，疗效优于硝酸甘油。
목적：관찰중조인뇌납태（rhBNP）치료급성심력쇠갈혹만성심력쇠갈급성발작환자적림상료효。방법납입65례급성혹만성심력쇠갈급성발작환자，수궤분위관찰조（n=33）화대조조（n=32）。재상규항심쇠치료적기출（이뇨제、혈관긴장소전환매억제제、β수체조체제등）상，관찰조급여rhBNP치료，수선정맥추주부하제량1.5μg/kg，수후이0.0075μg/（kg.min）유지정맥빙주48 h；대조조환자급여정맥빙입초산감유치료，기시제량5～10μg/min，근거혈압정황매차증가5～10μg，직지림상효응평균용량20μg/min，정맥빙입48h。관찰량조환자적치료효과급좌실사혈분수（LVEF）、혈청N단뇌납태전체（NT-proBNP）、폐동맥압（PAP）、심솔、호흡、주원시간、사망솔、3개월후6분종보행거리급재주원솔정황。결과관찰조화대조조환자적총유효솔분별위96.9%、68.8%，차이유통계학의의（P＜0.05）。치료전량조환자LVEF、혈청NT-proBNP농도급심솔、호흡빈솔、폐동맥압，무현저통계학차이（P＞0.05）。치료48h후，관찰조환자LVEF증가，혈청NT-proBNP농도심솔、호흡빈솔급폐동맥압강저，치료전후유통계학차이（P＜0.05）。이대조조환자상술지표재치료전후비교，무통계학차이（P＞0.05）。여대조조환자상비，관찰조환자주원시간명현축단、주원사망솔강저、3개월후6분종보행거리증가병차재주원솔강저，차이균유통계학의의（P＜0.05）。결론조기응용rhBNP치료급성심력쇠갈혹만성심력쇠갈급성발작，능경호적개선환자적증상급유후，료효우우초산감유。
Objective To observe the clinical efficacy of recombinant human brain natriuretic peptide (rhBNP) on acute heart failure or acute attacked chronic heart failure (CHF). Methods The patients (n=65) were randomly divided into observation group (n=33) and control group (n=32). On the base of routine treatment for heart failure (diuretics, ACE inhibitor,β-receptor blockers, etc.), observation group was given rhBNP [first dose=1.5μg/kg, maintaining dose=0.0075μg/(kg.min)], and control group was given nitroglycerin (first dose=5-10μg/min, increased 5μg-10μg according blood pressure until average dose=20μg/min) by intravenous pumping for 48 h. The clinical efficacy and changes of LVEF, NT-proBNP, pulmonary artery pressure (PAP), heart rate (HR), respiratory rate (RR), length of hospital stay, mortality, 6-minute walk distance (6MWD) after 3 m and rehospitalizing rate were observed in 2 groups. Results The total effective rate was 96.9%in observation group and 68.8%in control group (P<0.05). Before treatment the changes of LVEF, NT-proBNP, HR, RR and PAP had no statistical difference between 2 groups (P>0.05). After treatment for 48 h, LVEF increased, and NT-proBNP, HR, RR and PAP decreased in observation group (P<0.05), while in control group, all above indexes had no statistical difference before and after treatment (P>0.05). The length of hospital stay was shortened significantly, mortality decreased, 6MWD after 3 m incrased and rehospitalizing rate decreased in observation group compared with control group (P<0.05). Conclusion The early administration of rhBNP can relieve symptoms and improve prognosis in the patients with acute heart failure or acute attacked CHF, and its curative effect is better than that of nitroglycerin.