本文選題：急性失代償性心力衰竭 + 重組人腦利鈉肽�。� 參考：《中國藥房》2016年29期

【摘要】：目的:觀察重組人腦利鈉肽(rh BNP)聯(lián)合左西孟坦治療急性失代償性心力衰竭(ADHF)的臨床療效及安全性。方法:采用回顧性研究方法,將120例ADHF患者的臨床資料按治療方案不同分為觀察組和對照組,各60例。對照組患者在常規(guī)治療的基礎(chǔ)上給予凍干rh BNP,首先以0.15μg/kg的劑量靜脈沖擊,再以維持劑量0.007 5μg/(kg·min)連續(xù)靜脈泵注24~72 h;觀察組患者在對照組治療基礎(chǔ)上給予負(fù)荷劑量12μg/(kg·min)左西孟坦注射液靜脈滴注10 min,再以維持劑量0.1μg/(kg·min)靜脈泵注24 h,根據(jù)患者的臨床表現(xiàn)可酌情調(diào)整劑量。記錄兩組患者的生命體征、血流動力學(xué)和超聲心動圖指標(biāo)、呼吸困難好轉(zhuǎn)率、血漿BNP濃度、尿量及不良反應(yīng)發(fā)生情況。結(jié)果:除對照組患者在治療后1 h的生命體征和血流動力學(xué)指標(biāo)變化不明顯外,兩組患者治療后各時間點的心率(HR)、呼吸頻率(RR)、收縮壓(SBP)、平均肺動脈壓(MPAP)和平均肺毛細(xì)血管楔壓(MPCWP)均明顯低于治療前,血氧飽和度(Sa O2)和心輸出量(CO)均明顯高于治療前,差異均有統(tǒng)計學(xué)意義(P0.05);觀察組患者在治療后1、2、4 h的HR、RR、SBP、MPAP和MPCWP均明顯低于對照組,Sa O2和CO均明顯高于對照組,差異均有統(tǒng)計學(xué)意義(P0.05),其余各時間點的生命體征和血流動力學(xué)指標(biāo)組間比較,差異無統(tǒng)計學(xué)意義(P0.05)。治療后48 h,兩組患者的左室射血分?jǐn)?shù)均較治療前升高,血漿腦利鈉肽濃度均較治療前降低,且觀察組患者較對照組改善程度更明顯,差異均有統(tǒng)計學(xué)意義(P0.05)。觀察組患者治療后24、48 h的尿量均明顯高于對照組,差異均有統(tǒng)計學(xué)意義(P0.05)。兩組患者治療后各時間點的呼吸困難好轉(zhuǎn)率及不良反應(yīng)發(fā)生率比較,差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:rh BNP聯(lián)合左西孟坦能有效改善ADHF患者的生命體征、血流動力學(xué)和超聲心動圖指標(biāo)及呼吸困難癥狀,增加尿量,降低血漿BNP濃度,且安全性較高。
[Abstract]:Aim: to observe the clinical efficacy and safety of recombinant human brain natriuretic peptide (rh BNP) combined with levosimentam in the treatment of acute decompensated heart failure (ADHF). Methods: the clinical data of 120 patients with ADHF were divided into observation group and control group. Patients in the control group were given freeze-dried rh BNPs on the basis of routine therapy. The patients in the observation group were given a loading dose of 12 渭 g / (kg min) for 10 minutes and a maintenance dose of 0.1 渭 g / (kg min) for 24 h after continuous intravenous injection of 0.007 渭 g / (kg min) for 72 h, and the patients in the observation group were given a dose of 12 渭 g / (kg min) for 10 minutes. Performance can be adjusted as appropriate. Vital signs, hemodynamic and echocardiographic parameters, improvement rate of dyspnea, plasma BNP concentration, urine volume and adverse reactions were recorded. Results: the changes of vital signs and hemodynamic indexes in the control group were not obvious at 1 hour after treatment. Heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), mean pulmonary artery pressure (MPAP) and mean pulmonary capillary wedge pressure (MPCWP) were significantly lower than those before treatment, and blood oxygen saturation (SaO2) and cardiac output (CO) were significantly higher than those before treatment. There was significant difference between the two groups (P0.05), the values of HRRRRSBP MPAP and MPCWP in the observation group were significantly lower than those in the control group (P 0.05), and were significantly higher in the observation group than in the control group. The differences were statistically significant (P0.05), the other time points of vital signs and hemodynamic indicators of comparison between groups, the difference was not statistically significant (P0.05). 48 hours after treatment, the left ventricular ejection fraction (LVEF) in both groups was higher than that before treatment, and the plasma BNP concentration was lower than that before treatment, and the improvement was more obvious in the observation group than in the control group (P0.05). The urine volume of the patients in the observation group was significantly higher than that in the control group at 24 hours after treatment, and the difference was statistically significant (P0.05). The improvement rate of dyspnea and the incidence of adverse reactions were not significantly different between the two groups at each time point after treatment (P0.05). Conclusion the combination of RH BNP and levsimentanone can effectively improve the vital signs, hemodynamic and echocardiographic parameters, dyspnea symptoms, increase urine volume and decrease plasma BNP concentration in patients with ADHF.
【作者單位】： 棗莊礦業(yè)集團(tuán)棗莊醫(yī)院內(nèi)七科;棗莊市立醫(yī)院心內(nèi)科;棗莊礦業(yè)集團(tuán)棗莊醫(yī)院神經(jīng)內(nèi)科;
【分類號】：R541.6

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