本文選題：新活素 + 硝普鈉�。� 參考：《華北理工大學(xué)》2016年碩士論文

【摘要】：目的對(duì)比早期靜脈應(yīng)用新活素(重組人腦利鈉肽,Recombinant human brain natriuretic peptide,rh BNP)或硝普鈉治療急性心力衰竭患者的臨床療效及預(yù)后情況。方法連續(xù)收集自2014年3月至2015年6月期間唐山市工人醫(yī)院心內(nèi)一科收治的急性心力衰竭患者共計(jì)294例,隨機(jī)分為治療組(147例)與對(duì)照組(147例)。治療組在發(fā)病24小時(shí)內(nèi)運(yùn)用標(biāo)準(zhǔn)化抗心力衰竭治療方法的同時(shí)加用新活素,用微量泵以0.0075μg·kg~(-1)·min~(-1)靜脈泵入,維持治療7天;對(duì)照組在在發(fā)病24小時(shí)內(nèi)運(yùn)用標(biāo)準(zhǔn)化抗心力衰竭治療方法的同時(shí)加用硝普鈉注射液,首先在閉光條件下用微量泵以2μg·kg~(-1)·min~(-1)靜脈泵入,依據(jù)癥狀及血壓調(diào)整劑量,常用劑量給予3μg·kg~(-1)·min~(-1),極量為10μg·kg~(-1)·min~(-1),持續(xù)應(yīng)用7天。制定嚴(yán)格規(guī)范的研究調(diào)查表,詳細(xì)收集記錄患者的一般資料、用藥前后血液生化指標(biāo)(氨基末端前B型鈉尿肽、電解質(zhì)、腎功能)、尿量、超聲心功能檢查指標(biāo)(LVEF、SV、CI、CO)、血壓、住院天數(shù)、9個(gè)月內(nèi)心衰再住院率及死亡人數(shù)等各項(xiàng)數(shù)據(jù)。并將相關(guān)數(shù)據(jù)用Excel形式建立數(shù)據(jù)庫(kù),應(yīng)用SPSS21.0統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)分析。計(jì)數(shù)資料以百分率(%)表示,兩組間比較采用χ2檢驗(yàn)分析;計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(sx±)表示,兩組間比較采用t檢驗(yàn)分析;治療前后各指標(biāo)變化幅度以中位數(shù)(四分位數(shù)間距)[M(P25-P75)]表示,兩組間比較采用秩和檢驗(yàn)分析,P0.05表示差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果實(shí)驗(yàn)組與對(duì)照組患者的心功能狀況及24小時(shí)尿量情況治療后均較前明顯增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05),并且實(shí)驗(yàn)組治療后的心功能狀況、24小時(shí)尿量情況以及升高幅度均明顯優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);實(shí)驗(yàn)組與對(duì)照組患者的血漿NT-pro BNP水平治療后均較前明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),并且實(shí)驗(yàn)組治療后的血漿NT-pro BNP水平以及降低幅度明顯優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);對(duì)照組的血壓狀況治療后較前明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),但實(shí)驗(yàn)組治療后的血壓較前差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),并且對(duì)照組治療后的血壓降低幅度明顯大于實(shí)驗(yàn)組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);實(shí)驗(yàn)組與對(duì)照組的腎功能、電解質(zhì)水平治療前后以及變化幅度均無(wú)明顯不同,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);實(shí)驗(yàn)組的住院天數(shù)、9個(gè)月內(nèi)心衰再住院次數(shù)以及9個(gè)月內(nèi)死亡人數(shù)較對(duì)照組明顯減少,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1急性心力衰竭患者早期應(yīng)用新活素能進(jìn)一步改善患者心功能狀況,進(jìn)一步增加患者24小時(shí)尿量,進(jìn)一步降低患者血漿NT-pro BNP水平,對(duì)患者腎功能、電解質(zhì)無(wú)明顯影響,并且不會(huì)降低患者血壓水平;2急性心力衰竭患者早期應(yīng)用新活素能顯著減少急性心力衰竭患者住院天數(shù)、9個(gè)月內(nèi)心衰再住院率以及9個(gè)月內(nèi)死亡人數(shù)。
[Abstract]:Objective to compare the clinical effect and prognosis of patients with acute heart failure treated with recombinant human brain natriuretic peptide human brain natriuretic peptiderh BNPs or sodium nitroprusside. Methods A total of 294 patients with acute heart failure were collected from March 2014 to June 2015. The patients were randomly divided into treatment group (n = 147) and control group (n = 147). In the treatment group, the treatment group was treated with standardized anti-heart failure therapy within 24 hours and was treated with neovasin and 0.0075 渭 g kg 路kg ~ (-1) 路min ~ (-1) 路min ~ (-1). The treatment was maintained for 7 days. The control group was treated with standardized anti-heart failure therapy and sodium nitroprusside injection within 24 hours after the onset of the disease. First, the control group was injected intravenously with a micropump of 2 渭 g 路kg ~ (-1) 路min ~ (-1) under the condition of closed light. The dosage was adjusted according to the symptoms and blood pressure. The usual dose was 3 渭 g / kg / min ~ (-1) 路min ~ (-1) ~ (-1), and the maximum dose was 10 渭 g / kg ~ (-1) / min ~ (-1) / min ~ (-1) 路min ~ (-1) 路min ~ (-1) 路min ~ (-1) for 7 days. Make a strict and standardized research questionnaire, collect and record the general data of the patients in detail, and collect and record the general data of the patients in detail, and the blood biochemical indexes before and after medication (amino terminal B-type natriuretic peptide, electrolytes, renal function, urine volume, ultrasonic cardiac function index, LVEF / SVVCICOG, blood pressure, blood pressure, etc. Days of hospitalization, rehospitalization rate and death rate of heart failure within 9 months. The database is established in the form of Excel, and the statistical analysis is carried out by SPSS21.0 software package. The counting data were expressed as percentage, 蠂 2 test analysis was used for comparison between the two groups, and the mean 鹵standard deviation (sx 鹵) was used for the measurement data, and t test analysis was used for the comparison between the two groups. Before and after treatment, the range of changes of each index was the median (quartile spacing) [MU P25-P75], and the difference between the two groups was statistically significant by rank sum test (RSR) analysis (P0.05). Results the cardiac function and 24-hour urine volume of the patients in the experimental group and the control group were significantly increased after treatment. The difference was statistically significant (P 0.05), and the cardiac function of the experimental group was significantly better than that of the control group. The plasma NT-pro BNP level in the experimental group and the control group was significantly lower than that in the control group after treatment, and the difference was statistically significant (P 0.05), and the plasma NT-pro BNP level in the experimental group was significantly higher than that in the control group. The difference was statistically significant (P 0.05), and the blood pressure in the control group was significantly lower than that before treatment. The difference was statistically significant (P 0.05), but there was no significant difference in blood pressure between experimental group and control group after treatment, and the decrease of blood pressure in control group was significantly larger than that in experimental group (P 0.05), and the renal function of experimental group and control group was significantly higher than that of control group. There was no significant difference in electrolyte level before and after treatment, and the difference was not statistically significant (P 0.05). The days of hospitalization, the number of rehospitalization within 9 months and the number of deaths within 9 months in the experimental group were significantly lower than those in the control group. The difference was statistically significant (P 0.05). Conclusion (1) early application of neovasin in patients with acute heart failure can further improve the cardiac function, further increase the 24-hour urine volume, further reduce the plasma NT-pro BNP level, and have no significant effect on renal function and electrolytes in patients with acute heart failure. The early application of neovasin in patients with acute heart failure could significantly reduce the hospitalization days of patients with acute heart failure, the rehospitalization rate of heart failure within 9 months and the number of deaths within 9 months.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.6

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