CAJ | 학술논문

目的：探讨不同B型钠尿肽（BNP）水平下急性冠脉综合征（ACS）患者使用β受体阻滞剂的安全性。方法依据入院后即时BNP水平将231例ACS患者分3组：对照组（＜100μg/L）64例、灰带组（100~400μg/L）78例、升高组（＞400μg/L）89例。三组患者给予ACS常规治疗及初始剂量的β受体阻滞剂6.25 mg，每日2次。观察记录三组患者BNP浓度变化，血压、心率、心律、killip心功能分级，以及是否并发胸腔积液、下肢水肿和急性左侧心力衰竭。依据各组患者观察治疗期间出现的病情变化不同将其分为A、B和C事件，并根据不同事件确定是否继续使用β受体阻滞剂及其用量。结果三组间A事件和C事件发生率差异均有统计学意义（χ2=28.528、32.608，P均＜0.001），其中对照组A事件发生率最低，升高组A事件发生率最高；C事件在对照组中发生率最高，在升高组中发生率最低（P均＜0.017）。三组胸腔积液发生率差异有统计学意义，对照组最低，升高组最高（F=35.408，P＜0.001）。而下肢水肿的发生数三组相比差异没有统计学意义（χ2=2.973，P=0.226）。对照组β受体阻滞剂使用量最大，升高组最低，三组间差异有统计学意义（F=8.670，P＜0.001）。结论 ACS患者BNP水平越高，发生严重不良事件以及心功能下降和胸腔积液的风险也越高，依据BNP水平调整β受体阻滞剂使用剂量可以降低ACS患者并发症和严重不良事件的发生率。
목적：탐토불동B형납뇨태（BNP）수평하급성관맥종합정（ACS）환자사용β수체조체제적안전성。방법의거입원후즉시BNP수평장231례ACS환자분3조：대조조（＜100μg/L）64례、회대조（100~400μg/L）78례、승고조（＞400μg/L）89례。삼조환자급여ACS상규치료급초시제량적β수체조체제6.25 mg，매일2차。관찰기록삼조환자BNP농도변화，혈압、심솔、심률、killip심공능분급，이급시부병발흉강적액、하지수종화급성좌측심력쇠갈。의거각조환자관찰치료기간출현적병정변화불동장기분위A、B화C사건，병근거불동사건학정시부계속사용β수체조체제급기용량。결과삼조간A사건화C사건발생솔차이균유통계학의의（χ2=28.528、32.608，P균＜0.001），기중대조조A사건발생솔최저，승고조A사건발생솔최고；C사건재대조조중발생솔최고，재승고조중발생솔최저（P균＜0.017）。삼조흉강적액발생솔차이유통계학의의，대조조최저，승고조최고（F=35.408，P＜0.001）。이하지수종적발생수삼조상비차이몰유통계학의의（χ2=2.973，P=0.226）。대조조β수체조체제사용량최대，승고조최저，삼조간차이유통계학의의（F=8.670，P＜0.001）。결론 ACS환자BNP수평월고，발생엄중불량사건이급심공능하강화흉강적액적풍험야월고，의거BNP수평조정β수체조체제사용제량가이강저ACS환자병발증화엄중불량사건적발생솔。
Objective To investigate the safety of beta receptor blocker in acute coronary syndrome (ACS) patients based on the level of B-type natriuretic peptide (BNP). Methods A total of 231 ACS patients were classified into three groups according to their BNP level::control group (BNP<100μg/L, n=64), medium group (BNP 100 to 400μg/L, n=78) and high level group (BNP>400μg/L, n=89). All patients were treated with routine therapy plus beta receptor blocker (6.25 mg each time, twice a day). The BNP level, blood pressure, heart rate, heart rhythm, killip heart function classification, the occurrence of pleural effusions, lower limb edema and acute left heart failure were recorded. And the above indexes were divided into A, B, C events based on the disease evolution of patients in each group during the treatment, and according to the different events to determine whether to continue the use of beta receptor blockers and dosage. Resultls The occurrence rate of A and C events showed significant differences among the three groups ( χ2=28.528, 32.608, all P<0.001), and the control group had a lowest occurrence rates of A event but a highest occurrence rates of C event, while the high level group had a highest occurrence rates of A event but a lowest occurrence rates of C event (all P<0.017). The occurrence rate of pleural effusions has a significant difference among the three groups ( F=35.408, P<0.001), and it is highest in the high level group, but is lowest in the normal group. However, there were no significancet differences in the occurrence of lower limb edema among the three groups (χ2=2.973, P=0.226). And the beta-blockers usage in the control group were highest, and it decreased most in the high level group (F=8.670, P<0.001). Conclusions The higher level of BNP in ACS patients is correlated with the occurrence of pleural effusions and decreased heart function. The evaluation of BNP level is a guide to the use of beta receptor blocker, which is helpful to reduce the coincidence of ACS.