中国循证心血管医学杂志
中國循證心血管醫學雜誌
중국순증심혈관의학잡지
CHINESE JOURNAL OF EVIDENCE-BASES CARDIOVASCULAR MEDICINE
2014年
6期
704-707
,共4页
黄鑫涛%庞学民%李之恒%白保强%李小红
黃鑫濤%龐學民%李之恆%白保彊%李小紅
황흠도%방학민%리지항%백보강%리소홍
重组人脑钠肽%硝酸甘油%急性心肌梗死%前壁%心力衰竭%疗效
重組人腦鈉肽%硝痠甘油%急性心肌梗死%前壁%心力衰竭%療效
중조인뇌납태%초산감유%급성심기경사%전벽%심력쇠갈%료효
Recombinant human brain natriuretic peptide%Nitroglycerin%Acute myocardial infarction%Anterior wall%Heart failure%Curative effect
目的:比较重组人脑钠肽(rhBNP)与硝酸甘油治疗急性前壁心肌梗死(AAMI)合并失代偿性心力衰竭的疗效及安全性。方法选取2012年3月至2013年10月在驻马店市中心医院心内科CCU的AAMI合并失代偿性心力衰竭患者42例,男性29例,女性13例,年龄范围18~75岁。随机分为两组:脑钠肽组(20例)和硝酸甘油组(22例)。脑钠肽组在常规治疗基础上静脉泵入rhBNP;硝酸甘油组在常规治疗基础上静脉泵入硝酸甘油,均连续治疗72 h。两组患者治疗前后评定心功能分级,监测心率、血氧饱和度、72 h尿量等,检测左心室射血分数(LVEF)、左心室短轴缩短率(FS)、心脏指数(CI)、心输出量(CO)、二尖瓣血流舒张早期最大流速E峰与心房收缩期最大流速A峰的比值(E/A),并记录药物的不良反应,随访30 d内心血管不良事件情况。结果脑钠肽组总有效率高于硝酸甘油组(95.0%vs.63.6%),差异有统计学意义(P<0.05)。脑钠肽组治疗开始后各时间点肺毛细血管楔压(PCWP)和肺动脉压(PAP)均低于硝酸甘油组,差异具有显著统计学意义(P均<0.01)。治疗72 h后,与硝酸甘油组比较,脑钠肽组患者的心率、呼吸频率减少,血氧饱和度、72 h尿量增加,差异具有显著统计学意义(P均<0.01);收缩压和呋塞米用量降低(P均<0.05)。治疗72 h后,与硝酸甘油组比较,脑钠肽组患者的LVEF[(33.52±10.47)%vs.(46.86±11.32)%]、FS[(18.86±6.39)%vs.(22.40±6.55)%]、CI[(2.24±0.48)L/(min?m2)vs.(2.87±0.33)L/(min?m2)]、CO[(4.87±0.37)L/min vs.(5.16±0.42)L/min]、E/A[(0.85±0.17)vs.(0.93±0.19)]均升高,差异具有统计学意义(P均<0.05)。脑钠肽组发生症状性低血压1例,硝酸甘油组发生头部胀痛7例,低血压1例。随访30 d内心血管不良事件,脑钠肽组心血管不良事件发生率明显低于硝酸甘油组(5%vs.45.5%,P<0.05)。结论rhBNP能够降低PCWP、PAP,排钠利尿,改善血流动力学和心功能,减少心血管不良事件,不良反应较少,疗效与安全性优于硝酸甘油。
目的:比較重組人腦鈉肽(rhBNP)與硝痠甘油治療急性前壁心肌梗死(AAMI)閤併失代償性心力衰竭的療效及安全性。方法選取2012年3月至2013年10月在駐馬店市中心醫院心內科CCU的AAMI閤併失代償性心力衰竭患者42例,男性29例,女性13例,年齡範圍18~75歲。隨機分為兩組:腦鈉肽組(20例)和硝痠甘油組(22例)。腦鈉肽組在常規治療基礎上靜脈泵入rhBNP;硝痠甘油組在常規治療基礎上靜脈泵入硝痠甘油,均連續治療72 h。兩組患者治療前後評定心功能分級,鑑測心率、血氧飽和度、72 h尿量等,檢測左心室射血分數(LVEF)、左心室短軸縮短率(FS)、心髒指數(CI)、心輸齣量(CO)、二尖瓣血流舒張早期最大流速E峰與心房收縮期最大流速A峰的比值(E/A),併記錄藥物的不良反應,隨訪30 d內心血管不良事件情況。結果腦鈉肽組總有效率高于硝痠甘油組(95.0%vs.63.6%),差異有統計學意義(P<0.05)。腦鈉肽組治療開始後各時間點肺毛細血管楔壓(PCWP)和肺動脈壓(PAP)均低于硝痠甘油組,差異具有顯著統計學意義(P均<0.01)。治療72 h後,與硝痠甘油組比較,腦鈉肽組患者的心率、呼吸頻率減少,血氧飽和度、72 h尿量增加,差異具有顯著統計學意義(P均<0.01);收縮壓和呋塞米用量降低(P均<0.05)。治療72 h後,與硝痠甘油組比較,腦鈉肽組患者的LVEF[(33.52±10.47)%vs.(46.86±11.32)%]、FS[(18.86±6.39)%vs.(22.40±6.55)%]、CI[(2.24±0.48)L/(min?m2)vs.(2.87±0.33)L/(min?m2)]、CO[(4.87±0.37)L/min vs.(5.16±0.42)L/min]、E/A[(0.85±0.17)vs.(0.93±0.19)]均升高,差異具有統計學意義(P均<0.05)。腦鈉肽組髮生癥狀性低血壓1例,硝痠甘油組髮生頭部脹痛7例,低血壓1例。隨訪30 d內心血管不良事件,腦鈉肽組心血管不良事件髮生率明顯低于硝痠甘油組(5%vs.45.5%,P<0.05)。結論rhBNP能夠降低PCWP、PAP,排鈉利尿,改善血流動力學和心功能,減少心血管不良事件,不良反應較少,療效與安全性優于硝痠甘油。
목적:비교중조인뇌납태(rhBNP)여초산감유치료급성전벽심기경사(AAMI)합병실대상성심력쇠갈적료효급안전성。방법선취2012년3월지2013년10월재주마점시중심의원심내과CCU적AAMI합병실대상성심력쇠갈환자42례,남성29례,녀성13례,년령범위18~75세。수궤분위량조:뇌납태조(20례)화초산감유조(22례)。뇌납태조재상규치료기출상정맥빙입rhBNP;초산감유조재상규치료기출상정맥빙입초산감유,균련속치료72 h。량조환자치료전후평정심공능분급,감측심솔、혈양포화도、72 h뇨량등,검측좌심실사혈분수(LVEF)、좌심실단축축단솔(FS)、심장지수(CI)、심수출량(CO)、이첨판혈류서장조기최대류속E봉여심방수축기최대류속A봉적비치(E/A),병기록약물적불량반응,수방30 d내심혈관불량사건정황。결과뇌납태조총유효솔고우초산감유조(95.0%vs.63.6%),차이유통계학의의(P<0.05)。뇌납태조치료개시후각시간점폐모세혈관설압(PCWP)화폐동맥압(PAP)균저우초산감유조,차이구유현저통계학의의(P균<0.01)。치료72 h후,여초산감유조비교,뇌납태조환자적심솔、호흡빈솔감소,혈양포화도、72 h뇨량증가,차이구유현저통계학의의(P균<0.01);수축압화부새미용량강저(P균<0.05)。치료72 h후,여초산감유조비교,뇌납태조환자적LVEF[(33.52±10.47)%vs.(46.86±11.32)%]、FS[(18.86±6.39)%vs.(22.40±6.55)%]、CI[(2.24±0.48)L/(min?m2)vs.(2.87±0.33)L/(min?m2)]、CO[(4.87±0.37)L/min vs.(5.16±0.42)L/min]、E/A[(0.85±0.17)vs.(0.93±0.19)]균승고,차이구유통계학의의(P균<0.05)。뇌납태조발생증상성저혈압1례,초산감유조발생두부창통7례,저혈압1례。수방30 d내심혈관불량사건,뇌납태조심혈관불량사건발생솔명현저우초산감유조(5%vs.45.5%,P<0.05)。결론rhBNP능구강저PCWP、PAP,배납이뇨,개선혈류동역학화심공능,감소심혈관불량사건,불량반응교소,료효여안전성우우초산감유。
Objective To compare curative effect and safety between recombinant human brain natriuretic peptide (rhBNP) and nitroglycerin (NTG) in treatment of acute anterior myocardial infarction (AAMI) complicating acute decompensated heart failure (ADHF).Methods The patients (n=42, male 29, female 13 aged from 18 to 75) were chosen from Mar. 2012 to Oct. 2013, and randomly divided into rhBNP group (n=20) and NTG group (n=22). The rhBNP group was given rhBNP and NTG group was given NTG besides of routine therapies for 72 h continuously. The changes of heart function grading, heart rate (HR), oxygen saturation (SpO2), 72-h urine volume (72-h RUV), left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), cardiac index (CI), cardiac output (CO) and E/A were detected, and adverse reactions were recorded in 2 groups before and after treatment. The adverse cardiovascular events within 30 d were followed up.Results The total effective rate was higher in rhBNP group than that in NTG group (95.0%vs. 63.6%,P<0.05). The levels of PCWP and PAP were lower in rhBNP group than those in NTG group at all time points (allP<0.01). After treatment for 72 h, HR and respiratory rate decreased and SpO2 and 72-h RUV increased (allP<0.01), and SBP and furosemide dose decreased (allP<0.05) in rhBNP group compared with NTG group. After treatment for 72 h, LVEF [(33.52±10.47)%vs. (46.86±11.32)%], LVFS [(18.86±6.39)%vs. (22.40±6.55)%],CI [(2.24 ±0.48) L/(min·m2)vs. (2.87±0.33) L/(min·m2)], CO [(4.87±0.37) L/minvs. (5.16±0.42) L/min] and E/A [(0.85± 0.17)vs. (0.93±0.19) ] all increased in rhBNP group compared with NTG group (allP<0.05). In rhBNP group, there was 1 case with symptomatic hypotension, and in NTG group, there were 7 cases with headache and 1 with hypotension. The incidence of adverse cardiovascular events within 30 d was significantly lower in rhBNP group than that in NTG group (5% vs. 45.5%,P<0.05).Conclusion The treatment with rhBNP has effects of decreasing levels of PCWP and PAP, natriuresis, improving hemodynamics and heart function, reducing adverse cardiovascular events, and has less adverse reactions, and its curative effect and safety are higher than those of NTG.