小劑量rhBNP治療慢性充血性心力衰竭患者的療效性和安全性觀察
發(fā)布時(shí)間：2018-11-18 10:25
【摘要】：目的慢性心力衰竭5年生存率和惡性腫瘤相似,目前藥物治療目的主要包括改善心肌重塑、影響遠(yuǎn)期預(yù)后、緩解臨床癥狀以及保證近期生存率等方面,本研究主要通過對(duì)慢性充血性心力衰竭(chronic congestive heart failure,CCHF)患者早期小劑量持續(xù)靜脈泵入凍干重組人腦鈉肽(recombinant human brain natriuretic peptide,rh BNP,簡(jiǎn)稱新活素),觀察血漿氮-末端人腦鈉肽(N-Terminal Pro-brain Natriuretic Peptide,NT-pro BNP)、臨床癥狀緩解、超聲心動(dòng)圖參數(shù)變化以及血清肌酐、鈉離子、鉀離子濃度變化情況,并評(píng)估其臨床療效性及安全性。方法本次研究入選了2015.2-2016.2在安徽省立醫(yī)院心內(nèi)科住院,明確診斷為慢性充血性心力衰竭,且符合本次入選條件的患者80例。分為rh BNP組和常規(guī)治療組,其中常規(guī)治療組38例,rh BNP組42例。兩組均給予心力衰竭一般標(biāo)準(zhǔn)化治療,rh BNP組在常規(guī)的心力衰竭標(biāo)準(zhǔn)化治療的基礎(chǔ)上早期加用小劑量rh BNP靜脈泵入7 d,常規(guī)治療組給予等量生理鹽水治療。收集統(tǒng)計(jì)兩組患者治療前后的以下參數(shù):美國紐約心臟病協(xié)會(huì)(NYHA)心功能分級(jí)、行超聲心動(dòng)圖檢查:記錄左心室射血分?jǐn)?shù)(LVEF)、肺動(dòng)脈壓力(SPAP)、左心室舒張末內(nèi)徑(LVEDD)等參數(shù)、血肌酐濃度、血鉀離子濃度、血鈉離子濃度、血漿NT-pro BNP值以及所有入選患者治療期間24 h尿量,以心源性死亡、心力衰竭惡化需輔助通氣、實(shí)驗(yàn)藥物不能耐受為終點(diǎn)事件,分析比較rh BNP在治療CCHF時(shí)的療效性和安全性。結(jié)果(1)兩組患者治療前后血漿NT-pro BNP水平均有下降,rh BNP組由(4937±3009)pg/ml降至(2636±1670)pg/ml,常規(guī)治療組血漿NT-pro BNP水平由(4603±2640)pg/ml降至(3474±1964)pg/ml,統(tǒng)計(jì)分析結(jié)果表明rh BNP組NT-pro BNP水平下降更明顯,優(yōu)于常規(guī)治療組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)rh BNP組治療后紐約心功能分級(jí)改善更顯著(P0.05)。(3)兩組患者經(jīng)治療后,rh BNP組LVEF由(34±6)%增加至(44±6)%(P0.05),差異有統(tǒng)計(jì)學(xué)意義。rh BNP組SPAP和LVEDD雖較治療前有所改善,但改善不顯著,差異無統(tǒng)計(jì)學(xué)意義(P0.05);常規(guī)治療組LVEF、SPAP和LVEDD治療前后變化均無統(tǒng)計(jì)學(xué)差異。(4)rh BNP組治療期間人均尿量(2429±824)ml優(yōu)于常規(guī)治療組水平(2136±581)ml,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)兩組患者治療前后血清肌酐、鈉離子、鉀離子水平均無顯著性差異(P0.05)。結(jié)論早期持續(xù)應(yīng)用小劑量凍干重組人腦鈉肽治療慢性充血性心力衰竭患者,可在傳統(tǒng)標(biāo)準(zhǔn)化心力衰竭治療的基礎(chǔ)上可進(jìn)一步提高LVEF、降低血漿NT-pro BNP、增加尿量、改善患者NYHA分級(jí),其臨床療效優(yōu)于傳統(tǒng)治療,且安全性好,不影響患者腎功能及其電解質(zhì)濃度。
[Abstract]:Objective the 5-year survival rate of chronic heart failure is similar to that of malignant tumor. At present, drug therapy aims at improving myocardial remodeling, affecting long-term prognosis, relieving clinical symptoms and ensuring short-term survival rate. In this study, early low-dose continuous intravenous infusion of freeze-dried recombinant human brain natriuretic peptide (recombinant human brain natriuretic peptide,rh BNP,) was performed in patients with chronic congestive heart failure (chronic congestive heart failure,CCHF). To observe the changes of plasma N-terminal human brain natriuretic peptide (N-Terminal Pro-brain Natriuretic Peptide,NT-pro BNP),) in clinical symptom relief, echocardiographic parameters and serum creatinine, sodium ion and potassium ion concentration. The clinical efficacy and safety were evaluated. Methods 80 patients with chronic congestive heart failure (CHF) were enrolled in this study in Anhui Provincial Hospital from May 2 to June 2012.There were 80 patients who were diagnosed as chronic congestive heart failure (CHF). The patients were divided into rh BNP group and routine treatment group, including 38 cases of routine treatment group and 42 cases of, rh BNP group. Both groups were given general standardized treatment for heart failure. The, rh BNP group was given the same amount of normal saline at the early stage on the basis of routine standardized treatment of heart failure and intravenous infusion of small dose of rh BNP for 7 days. The following parameters were collected before and after treatment: (NYHA) cardiac function grading, echocardiography, left ventricular ejection fraction (LVEF),) pulmonary artery pressure (SPAP),) were recorded by the New York Heart Association. The parameters of left ventricular end-diastolic diameter (LVEDD), serum creatinine concentration, serum potassium ion concentration, plasma sodium ion concentration, plasma NT-pro BNP value, and 24 h urine volume during treatment in all patients died of cardiogenic death. Auxiliary ventilation was required for the deterioration of heart failure. The efficacy and safety of rh BNP in the treatment of CCHF were analyzed and compared. Results (1) Plasma NT-pro BNP levels decreased from (4937 鹵3009) pg/ml to (2636 鹵1670) pg/ml, in both groups before and after treatment. Plasma NT-pro BNP levels in routine treatment group decreased from (4603 鹵2640) pg/ml to (3474 鹵1964) pg/ml,. The results of statistical analysis showed that the level of NT-pro BNP in rh BNP group was significantly lower than that in routine treatment group. The difference was statistically significant (P0.05). (2) rh BNP group, P 0.05). (3) the LVEF of, rh BNP group increased from (34 鹵6)% to (44 鹵6)% (P0.05). There was significant difference between SPAP and LVEDD in. Rh BNP group, but the improvement was not significant (P0.05). There was no significant difference in LVEF,SPAP and LVEDD before and after treatment in routine treatment group (4) urine volume per capita in) rh BNP group (2429 鹵824) ml was better than that in routine treatment group (2136 鹵581) ml,. There was no significant difference in serum creatinine, sodium ion and potassium ion between the two groups before and after treatment (P0.05). Conclusion early continuous use of low-dose lyophilized recombinant human brain natriuretic peptide in the treatment of patients with chronic congestive heart failure can further improve LVEF, and reduce plasma NT-pro BNP, and increase urine volume in patients with chronic congestive heart failure on the basis of traditional standardized heart failure treatment. The improvement of NYHA grade was superior to the traditional treatment, and the safety was good, and the renal function and electrolyte concentration were not affected.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.61
本文編號(hào)：2339778
[Abstract]:Objective the 5-year survival rate of chronic heart failure is similar to that of malignant tumor. At present, drug therapy aims at improving myocardial remodeling, affecting long-term prognosis, relieving clinical symptoms and ensuring short-term survival rate. In this study, early low-dose continuous intravenous infusion of freeze-dried recombinant human brain natriuretic peptide (recombinant human brain natriuretic peptide,rh BNP,) was performed in patients with chronic congestive heart failure (chronic congestive heart failure,CCHF). To observe the changes of plasma N-terminal human brain natriuretic peptide (N-Terminal Pro-brain Natriuretic Peptide,NT-pro BNP),) in clinical symptom relief, echocardiographic parameters and serum creatinine, sodium ion and potassium ion concentration. The clinical efficacy and safety were evaluated. Methods 80 patients with chronic congestive heart failure (CHF) were enrolled in this study in Anhui Provincial Hospital from May 2 to June 2012.There were 80 patients who were diagnosed as chronic congestive heart failure (CHF). The patients were divided into rh BNP group and routine treatment group, including 38 cases of routine treatment group and 42 cases of, rh BNP group. Both groups were given general standardized treatment for heart failure. The, rh BNP group was given the same amount of normal saline at the early stage on the basis of routine standardized treatment of heart failure and intravenous infusion of small dose of rh BNP for 7 days. The following parameters were collected before and after treatment: (NYHA) cardiac function grading, echocardiography, left ventricular ejection fraction (LVEF),) pulmonary artery pressure (SPAP),) were recorded by the New York Heart Association. The parameters of left ventricular end-diastolic diameter (LVEDD), serum creatinine concentration, serum potassium ion concentration, plasma sodium ion concentration, plasma NT-pro BNP value, and 24 h urine volume during treatment in all patients died of cardiogenic death. Auxiliary ventilation was required for the deterioration of heart failure. The efficacy and safety of rh BNP in the treatment of CCHF were analyzed and compared. Results (1) Plasma NT-pro BNP levels decreased from (4937 鹵3009) pg/ml to (2636 鹵1670) pg/ml, in both groups before and after treatment. Plasma NT-pro BNP levels in routine treatment group decreased from (4603 鹵2640) pg/ml to (3474 鹵1964) pg/ml,. The results of statistical analysis showed that the level of NT-pro BNP in rh BNP group was significantly lower than that in routine treatment group. The difference was statistically significant (P0.05). (2) rh BNP group, P 0.05). (3) the LVEF of, rh BNP group increased from (34 鹵6)% to (44 鹵6)% (P0.05). There was significant difference between SPAP and LVEDD in. Rh BNP group, but the improvement was not significant (P0.05). There was no significant difference in LVEF,SPAP and LVEDD before and after treatment in routine treatment group (4) urine volume per capita in) rh BNP group (2429 鹵824) ml was better than that in routine treatment group (2136 鹵581) ml,. There was no significant difference in serum creatinine, sodium ion and potassium ion between the two groups before and after treatment (P0.05). Conclusion early continuous use of low-dose lyophilized recombinant human brain natriuretic peptide in the treatment of patients with chronic congestive heart failure can further improve LVEF, and reduce plasma NT-pro BNP, and increase urine volume in patients with chronic congestive heart failure on the basis of traditional standardized heart failure treatment. The improvement of NYHA grade was superior to the traditional treatment, and the safety was good, and the renal function and electrolyte concentration were not affected.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.61
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