CAJ | 학술논문

目的：探讨新活素(rhBNP)治疗内科危重症合并心力衰竭患者的临床疗效及安全性。方法选择我院重症内科2013年1~8月应用新活素辅助治疗的20例急性心力衰竭患者,观察患者治疗前及治疗后72h和7d的心率、呼吸频率、血压、24h尿量、肝肾功能、血浆氨基末端脑钠肽前体(NT-proBNP)变化。结果19例患者心功能明显改善,总有效率95%,新活素治疗后半小时患者呼吸频率、心率即有明显改善(P<0.05),72h及7d后呼吸频率、心率持续改善(P<0.05)；新活素治疗3 d后患者尿量明显增加(P<0.05),7d后尿量不再增加,但部分患者应用利尿剂剂量明显减少；新活素治疗后半小时患者血压下降,但72h及7d后血压可恢复(P>0.05)；新活素治疗后72h NT-proBNP即有明显下降(P<0.05),7d后下降更为明显,新活素治疗前后患者血清肌酐、尿素氮及谷丙转氨酶无明显变化(P>0.05)。治疗过程中可出现一过性低血压和心律失常,但发生率低。结论新活素对急性心力衰竭的短期疗效显著,对肝肾功能无明显影响。
목적：탐토신활소(rhBNP)치료내과위중증합병심력쇠갈환자적림상료효급안전성。방법선택아원중증내과2013년1~8월응용신활소보조치료적20례급성심력쇠갈환자,관찰환자치료전급치료후72h화7d적심솔、호흡빈솔、혈압、24h뇨량、간신공능、혈장안기말단뇌납태전체(NT-proBNP)변화。결과19례환자심공능명현개선,총유효솔95%,신활소치료후반소시환자호흡빈솔、심솔즉유명현개선(P<0.05),72h급7d후호흡빈솔、심솔지속개선(P<0.05)；신활소치료3 d후환자뇨량명현증가(P<0.05),7d후뇨량불재증가,단부분환자응용이뇨제제량명현감소；신활소치료후반소시환자혈압하강,단72h급7d후혈압가회복(P>0.05)；신활소치료후72h NT-proBNP즉유명현하강(P<0.05),7d후하강경위명현,신활소치료전후환자혈청기항、뇨소담급곡병전안매무명현변화(P>0.05)。치료과정중가출현일과성저혈압화심률실상,단발생솔저。결론신활소대급성심력쇠갈적단기료효현저,대간신공능무명현영향。
Objective To explore the clinical effect and safety of rhBNP in the treatment of patients with critical illness complicated with heart failure. Methods Twenty patients with acute heart failure who were given rhBNP as an assisted treatment from the department of critical care medicine in our hospital from January to August 2013 were selected. Changes of heart rate,respiratory rate,blood pressure,24-hour urine volume,hepatic and renal functions,NT-proB-NP in the patients before the treatment, 72 hours and 7 days after the treatment were observed. Results 19 patients showed obvious improvement of heart function, with the total effective rate of 95%. Patients'respiratory rate and heart rate 30 minutes after the treatment showed significant improvement(P<0.05),and the improvement continued 72 hours and 7 days after the treatment (P<0.05); urine volume increased significantly 3 days after the treatment with rhBNP(P<0.05). The volume remained stable after 7 days, but some patients significantly reduced their dosage of diuretics;blood pressure decreased 30 minutes after the treatment, and it recovered to normal level after 72 hours and 7 days(P>0.05);NT-proBNP reduced obviously 72 hours after the treatment(P<0.05),and the reduction became significant after 7 days. There were no significant changes in patients' serum creatinine, urea nitrogen and glutamic-pyruvic transaminase (P>0.05). Transient low blood pressure and arrhythmia could be detected in the treatment, but the inci-dence was low. Conclusion RhBNP has favorable effect on acute heart failure in a short period without any significant negative effect on hepatic and renal functions.