CAJ | 학술논문

目的：观察重症心衰合并肾功能不全患者在常规抗心衰、保肾治疗基础上应用前列地尔注射液的安全性及有效性。方法选择2013年11月至2014年10月期间沈阳军区总医院收治的重症心衰合并肾功能不全住院患者30例，将其随机分为对照组和治疗组，各15例。两组均给予心衰常规治疗及基础保肾治疗。治疗组在常规治疗基础上加用凯时10μg+0.9%NaCl注射液100 ml缓慢静脉滴注，2次/d，连续用药7 d。分别记录用药当天、第3天、第7天肌酐、肌酐清除率、治疗前后氨基末端-脑利钠肽前体（NT-proBNP）和左室射血分数（LVEF）。结果两组患者心功能和肾功能均得到改善。NT-proBNP和肌酐均较入院时下降，但与对照组相比，治疗组患者NT-proBNP下降更为明显（P<0.05），用药过程中个别患者出现轻微不良反应，但不影响治疗。结论（1）重症心衰合并肾功能不全患者在常规治疗基础上，加用小剂量前列地尔注射液对于患者心肾功能的改善是安全且有效的；（2）NT-proBNP可作为重症心衰患者危险分层的可靠标记物。
목적：관찰중증심쇠합병신공능불전환자재상규항심쇠、보신치료기출상응용전렬지이주사액적안전성급유효성。방법선택2013년11월지2014년10월기간침양군구총의원수치적중증심쇠합병신공능불전주원환자30례，장기수궤분위대조조화치료조，각15례。량조균급여심쇠상규치료급기출보신치료。치료조재상규치료기출상가용개시10μg+0.9%NaCl주사액100 ml완만정맥적주，2차/d，련속용약7 d。분별기록용약당천、제3천、제7천기항、기항청제솔、치료전후안기말단-뇌리납태전체（NT-proBNP）화좌실사혈분수（LVEF）。결과량조환자심공능화신공능균득도개선。NT-proBNP화기항균교입원시하강，단여대조조상비，치료조환자NT-proBNP하강경위명현（P<0.05），용약과정중개별환자출현경미불량반응，단불영향치료。결론（1）중증심쇠합병신공능불전환자재상규치료기출상，가용소제량전렬지이주사액대우환자심신공능적개선시안전차유효적；（2）NT-proBNP가작위중증심쇠환자위험분층적가고표기물。
Objective To observe effectiveness and safety of alprostadil in the treatment of severe heart failure with renal insufficiency patients on the basis of conventional therapy. Methods There were all 30 cases of severe heart failure with renal insufficiency patients whom were hospitalized in the General Hospital of Shenyang Military Area Command during 2013 November to 2014 October. They were randomly divided into treatment group(15cases) and control group(15cases). Control group was given conventional therapy and treatment group received both conventional therapy and alprostadil therapy (using alprostadil 10 ug+0.9%Sodium Chloride Injection100 ml,ivgtt,once time a day and,continuous application for 7 days. Collected serum creatinine,creatinine clearance rate,NT-proBNP and LVEF at first day,third day and seventh day. Also observed the adverse reactions during the application of alprostadil. Results After the treatment of conventional therapy,the symtoms and signs of the two groups patients were both improved .The Scr and NT-proBNP were significantly reduced(P<0.05). Compared with control group,the Ccr was significantly increased in treatment group,while it did not have statitical significance(P>0.05). There was no adverse reaction during alprostadil treatment. Conclusion Alprostadil is safe and effective in the treatment of severe heart failure with renal insufficiency patients. It can improve the function of kidney and heart in these patients. NT-proBNP can be used as a reliable marker for risk stratification in patients with severe heart failure.