中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2015年
8期
673-677
,共5页
魏菊屏%郭丽魁%樊欣娜%张晶
魏菊屏%郭麗魁%樊訢娜%張晶
위국병%곽려괴%번흔나%장정
围生期心肌病%顽固性心力衰竭%重组人B型钠尿肽%心功能
圍生期心肌病%頑固性心力衰竭%重組人B型鈉尿肽%心功能
위생기심기병%완고성심력쇠갈%중조인B형납뇨태%심공능
Peripartum cardiomyopathy%Refractory heart failure%Recombinent human B-type natriuretic peptide%Heart function
目的 评估重组人B型钠尿肽(rhBNP)治疗对围生期心肌病伴顽固性心力衰竭(PPCM-RHF)患者心功能的影响.方法 选取2010年1月至2014年1月在我院连续住院的PPCM-RHF患者61例,应用随机数字表分为rhBNP组30例和常规治疗组31例.两组均给予常规治疗,rhBNP组在常规治疗基础上给予rhBNP 1.5 μg/kg,2 min内匀速静脉注射后,以0.007 5 μg/(kg·min)静脉泵入,在收缩压(SBP)≥85 mmHg(1 mmHg=0.133 kPa),平均动脉压(MBP)≥65 mmHg的状态下,可调整剂量至0.015～0.030 μg/(kg·min),持续给药24h.记录呼吸困难改善情况并分别于给药前、用药后6h、14 d、30 d测定血浆BNP浓度.于给药前、用药24h、14 d和30 d分别行心脏超声检查,测定左心室射血分数(LVEF)和左心室舒张末期容积(LVEDD).记录30 d内主要心脏不良事件发生情况.结果 rhBNP组患者呼吸困难缓解时间(1.69±1.07)h显著短于对照组(2.69±1.39)h,P=0.002);rhBNP组血浆BNP水平用药后6 h(296.50±123.25) ng/L、14 d(141.37±69.54) ng/L、30 d(107.41±33.69) ng/L较基线时(727.07±146.84) ng/L明显降低.rhBNP组的LVEDD用药后24 h(52.23±4.54) mm、14 d (49.60±4.20) mm、30 d(42.59±3.90) mm均显著优于对照组[(56.33±4.38)、(53.03±4.95)、(48.85±4.96)mm],差异有统计学意义(P均＜0.05);两组间应用不同的药物后LVEF差异无统计学意义.但rhBNP组用药后24 h(41.13±4.12)％、14 d(43.00±4.10)％、30 d(44.52±3.43)％较基线时(36.73±5.82)％明显升高.30 d内主要心脏不良事件发生率rhBNP组明显少于对照组[10％ (3/30)与42％(13/31),P=0.005).结论 较常规治疗,rhBNP可及时有效地改善PPCM-RHF患者的心脏功能,减少30 d主要心脏不良事件的发生,改善患者的预后.
目的 評估重組人B型鈉尿肽(rhBNP)治療對圍生期心肌病伴頑固性心力衰竭(PPCM-RHF)患者心功能的影響.方法 選取2010年1月至2014年1月在我院連續住院的PPCM-RHF患者61例,應用隨機數字錶分為rhBNP組30例和常規治療組31例.兩組均給予常規治療,rhBNP組在常規治療基礎上給予rhBNP 1.5 μg/kg,2 min內勻速靜脈註射後,以0.007 5 μg/(kg·min)靜脈泵入,在收縮壓(SBP)≥85 mmHg(1 mmHg=0.133 kPa),平均動脈壓(MBP)≥65 mmHg的狀態下,可調整劑量至0.015～0.030 μg/(kg·min),持續給藥24h.記錄呼吸睏難改善情況併分彆于給藥前、用藥後6h、14 d、30 d測定血漿BNP濃度.于給藥前、用藥24h、14 d和30 d分彆行心髒超聲檢查,測定左心室射血分數(LVEF)和左心室舒張末期容積(LVEDD).記錄30 d內主要心髒不良事件髮生情況.結果 rhBNP組患者呼吸睏難緩解時間(1.69±1.07)h顯著短于對照組(2.69±1.39)h,P=0.002);rhBNP組血漿BNP水平用藥後6 h(296.50±123.25) ng/L、14 d(141.37±69.54) ng/L、30 d(107.41±33.69) ng/L較基線時(727.07±146.84) ng/L明顯降低.rhBNP組的LVEDD用藥後24 h(52.23±4.54) mm、14 d (49.60±4.20) mm、30 d(42.59±3.90) mm均顯著優于對照組[(56.33±4.38)、(53.03±4.95)、(48.85±4.96)mm],差異有統計學意義(P均＜0.05);兩組間應用不同的藥物後LVEF差異無統計學意義.但rhBNP組用藥後24 h(41.13±4.12)％、14 d(43.00±4.10)％、30 d(44.52±3.43)％較基線時(36.73±5.82)％明顯升高.30 d內主要心髒不良事件髮生率rhBNP組明顯少于對照組[10％ (3/30)與42％(13/31),P=0.005).結論 較常規治療,rhBNP可及時有效地改善PPCM-RHF患者的心髒功能,減少30 d主要心髒不良事件的髮生,改善患者的預後.
목적 평고중조인B형납뇨태(rhBNP)치료대위생기심기병반완고성심력쇠갈(PPCM-RHF)환자심공능적영향.방법 선취2010년1월지2014년1월재아원련속주원적PPCM-RHF환자61례,응용수궤수자표분위rhBNP조30례화상규치료조31례.량조균급여상규치료,rhBNP조재상규치료기출상급여rhBNP 1.5 μg/kg,2 min내균속정맥주사후,이0.007 5 μg/(kg·min)정맥빙입,재수축압(SBP)≥85 mmHg(1 mmHg=0.133 kPa),평균동맥압(MBP)≥65 mmHg적상태하,가조정제량지0.015～0.030 μg/(kg·min),지속급약24h.기록호흡곤난개선정황병분별우급약전、용약후6h、14 d、30 d측정혈장BNP농도.우급약전、용약24h、14 d화30 d분별행심장초성검사,측정좌심실사혈분수(LVEF)화좌심실서장말기용적(LVEDD).기록30 d내주요심장불량사건발생정황.결과 rhBNP조환자호흡곤난완해시간(1.69±1.07)h현저단우대조조(2.69±1.39)h,P=0.002);rhBNP조혈장BNP수평용약후6 h(296.50±123.25) ng/L、14 d(141.37±69.54) ng/L、30 d(107.41±33.69) ng/L교기선시(727.07±146.84) ng/L명현강저.rhBNP조적LVEDD용약후24 h(52.23±4.54) mm、14 d (49.60±4.20) mm、30 d(42.59±3.90) mm균현저우우대조조[(56.33±4.38)、(53.03±4.95)、(48.85±4.96)mm],차이유통계학의의(P균＜0.05);량조간응용불동적약물후LVEF차이무통계학의의.단rhBNP조용약후24 h(41.13±4.12)％、14 d(43.00±4.10)％、30 d(44.52±3.43)％교기선시(36.73±5.82)％명현승고.30 d내주요심장불량사건발생솔rhBNP조명현소우대조조[10％ (3/30)여42％(13/31),P=0.005).결론 교상규치료,rhBNP가급시유효지개선PPCM-RHF환자적심장공능,감소30 d주요심장불량사건적발생,개선환자적예후.
Objective To investigate the efficacy of recombinent human B-type natriuretic peptide (rhBNP) in peripartum cardiomyopathy (PPCM) with refractory heart failure (RHF).Methods From January 2010 to January 2014,a total of 61 patients with PPCM-RHF of the First Hospital of Qinhuangdao were enrolled into this study.All patients were randomly assigned into the rhBNP group (30 cases) and control group (31 cases).rhBNP was given 1.5 μg/kg,2 mim intravenously in rhBNP group and then infused intravenously 0.007 5-0.030 μg/(kg · min) for 24 hours,0.015-0.030 μg/(kg · min) for 24 hours when systolic blood pressure(SBP) ≥ 85 mmHg (1 mmHg =0.133 kPa) and mean brachial arterial pressure (MBP) ≥ 65 mmHg.Routine therapy followed the clinic practice was administrated in control group for 24 hours.Recorded the dyspnea change.Blood samples were collected at different time points to investigate BNP at 6 h,14 d and 30 d.Ultrasonic cardiography (UCG) was performed to evaluate left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension(LVEDD) before the initiation of the infusion,at day 1,14 and 30 after the infusion.All patients were followed up for one month to record the main adverse cardiac events (MACE),including heart failure recurrence,cardiac death and ventricular fibrillation and tachycardia.Results The time of dyspnea resolved in rhBNP group was significantly shorter than control group ((1.69 ± 1.07) h vs (2.69 ±1.39) h,P =0.002).Concentration of plasma BNP(6 h:(296.50±123.25) ng/L,14 d:(141.37±69.54) ng/L,30 d:(107.41±33.69) ng/L) was signifisantly reduced in both groups than basic line (727.07 =± 146.84) ng/L,and it was significantly different between two groups.LVEF raised and LVEDD decreased were observed at 24 hours((52.23±4.54) mm),14 d((49.60±4.20) mm) and 30 d((42.59±3.90) mm) in rhBNP group and were significant better than the control group ((56.33 ± 4.38) mm,(53.03 ± 4.95) mm,(48.85±4.96) mm;P ＜0.05).There was no significant difference in term of LVEF between two groups after treatment.However,24 h(4.12±41.13)％,14 d(4.10±43)％,30 d(44.52±3.43)％ were significantly higher than the baseline(36.73±5.82)％ in rhBNP group.MACEs were lower in rhBNP group at 30 dayscontrast to the control(10％ (3/30) vs.42％ (13/31);P =0.005).Conclusion Compared with conventional treatment,rhBNP can effectively improve the heart function in patients with PPCM-RHF,reduce the occurrence of major adverse cardiac events in 30 d,and improve the prognosis of patients.
