重组人脑利钠肽联合参附注射液治疗急性心肌梗死伴急性心力衰竭的疗效评价
Effect of recombinant human brain natriuretic peptide combined with Shenfu injection in the treatment of acute myocardial infarction complicated with acute heart failure
-
摘要: 目的：评价重组人脑利钠肽（rhBNP）和参附注射液联合治疗急性心肌梗死（AMI）伴急性心力衰竭（AHF）病人的有效性和安全性。方法：将符合AMI伴AHF诊断标准并排除心源性休克的病人随机分为rhBNP治疗组（rhBNP组）和rhBNP联合参附注射液治疗组（联合组），各31例。比较2组治疗前后血压、心率、尿量、呼吸困难程度、神经内分泌激素水平和超声心动图指标的变化及临床终点事件、不良反应发生率。结果：与rhBNP组比较，联合组舒张压和心率下降程度差异无统计学意义（P>0.05）；治疗期间每24 h的尿量均增多明显（P<0.01）；明显改善呼吸困难（P<0.01）；神经内分泌激素的水平明显下降（P<0.01）。用药后6个月，联合组LVEF明显升高（P<0.01）；LVEDD有轻度减小（P<0.05）。与rhBNP组比较，联合组低血压的发生率较低（P<0.05）；在保证收缩压130~90 mmHg及舒张压80~60 mmHg的情况下，2组病人均未出现肾功能不全或原有肾功能不全加重。结论：rhBNP能有效抑制AMI伴AHF病人的神经内分泌激素的激活，改善血流动力学；rhBNP联合参附注射液治疗更有利于改善呼吸困难的程度，控制心衰，更有助于左心室收缩功能的恢复。Abstract: Objective:To evaluate the efficacy and safety of the recombinant human brain natriuretic peptide (rhBNP) combined with Shenfu injection in treating acute myocardial infarction (AMI) complicated with acute heart failure (AHF).Methods:Sixty-two patients with AMI complicated with AHF were randomly divided into the rhBNP treatment group and rhBNP combined with Shenfu injection treatment group(combination group)(31 cases each group).The blood pressre,heart rate,24 hours urine output,dyspnea grade,plasma concentration of neuroendocrine hormone,ultrasonic cardiography parameters and incidence rate of adverse reaction between two groups before and after treatment were compared.Results:Compared with the rhBNP group,the differences of the diastolic pressure decreasing degree were not statistically significant(P>0.05),the 24 hours urine output increasing was obvious(P<0.01),the dyspnea improvement was significant(P<0.01),and the neuroendocrine hormone decreasing was obvious in combination group(P<0.01).After 6 months of treatment,the left ventricular ejection fraction significnatly increased(P<0.01),and the left ventricular end-diastolic dimension slightly decreased(P<0.05).Compared with the rhBNP group,the incidence rate of hypotension in combination group was lower(P<0.05).Under the SBP for 130 to 90 mmHg and DBP for 80 to 60 mmHg,no renal insufficiency or renal insufficiency aggravating in two groups was found.Conclusions:The rhBNP can effectively inhibit the activation of neuroendocrine hormone,and improve hemodynamics in patients with AMI complicated with AHF.The rhBNP combined with Shenfu injection can effectively improve the dyspnea,control heart failure,and promote the recovery left ventricular ejection fraction in patients with AMI complicated with AHF.
-
[1] 陈红伟.重组人脑利钠肽联合左西孟旦治疗急性心肌梗死合并心力衰竭的临床疗效[J].中国校医,2017,31(8):605. [2] 唐娜,褚庆民.参附注射液联合rhBNP治疗急性心力衰竭的临床观察[J/OL].中西医结合心脑血管病杂志,2017,(14):1733. [3] 张生友.重组人脑利钠肽(rhBNP)联合左西孟旦治疗急性心肌梗死合并心力衰竭的疗效[J].中国农村卫生,2017(10):94. [4] 刘树理,尤荣开,潘景业.BiPAP联合重组人脑利钠肽治疗急性心肌梗死并发心力衰竭临床观察[J].浙江实用医学,2017,22(1):11. [5] 鞠延玲.重组人脑利钠肽联合左西孟旦治疗急性心肌梗死合并心力衰竭的疗效及安全性[J].中国现代药物应用,2016,10(24):90. [6] 沈长松.重组人脑利钠肽联合左西孟旦治疗急性心肌梗死合并心力衰竭效果观察[J].中国乡村医药,2016,23(24):38. [7] 杨铁骊,张卉,张小方,等.参附注射液联合重组人脑利钠肽治疗急性左心衰竭102例疗效观察[J].中成药,2016,38(8):1875. [8] 孟凡祥.参附注射液联合重组人脑利钠肽治疗硝酸盐干预后效果不佳扩张型心肌病的临床研究[J].现代药物与临床,2016,31(6):780. [9] 孙艳霞.重组人脑利钠肽联合参附注射液治疗急性心肌梗死伴急性心力衰竭的临床治疗及疗效评价[J].当代医学,2016,22(15):144. [10] 赵进,赵强,吴同果.重组人脑利钠肽联合参附治疗急性心肌梗死并泵衰竭的疗效评价[J].现代中西医结合杂志,2016,25(13):1413. [11] 王娟,张勇,何江,等.阿托伐他汀联合重组人脑利钠肽治疗急性心肌梗死合并心力衰竭的临床观察[J].中国药房,2016,27(9):1182. [12] 王冬,王岩.左西孟旦及重组人脑利钠肽联合治疗急性心肌梗死合并心功能不全患者的临床观察[J].中国药物经济学,2015,10(S2):101. [13] 龙双祁,刘彬,邹桂和,等.替罗非班联合重组人脑利钠肽治疗急性心肌梗死伴心力衰竭患者的疗效分析[J/OL].中外医疗,2015,34(10):97. [14] 黄烨,周玲玲.重组人脑钠肽联合参麦注射液治疗充血性心力衰竭69例临床分析[J].中国临床医生杂志,2015,43(2):53. [15] 陈泽芳.无创呼吸机联合重组人脑利钠肽治疗急性心肌梗死并心力衰竭的研究[J].临床医学工程,2014,21(11):1439. [16] 廖佳芬,孔彬,王磊.重组人脑利钠肽对中国人群急性心衰患者疗效和安全性的Meta分析[J].武汉大学学报(医学版),2015,36(3):477. [17] 张利宣,李原,汪雁博,等.重组人脑利钠肽对急性冠脉综合征伴心力衰竭患者神经内分泌激素和心功能的影响[J].中国药业,2015,24(7):29. [18] FERMANN GJ,COLLINS SP.Initial management of patients with acute heart failure[J].Heart Fail Clin,2013,9(3):291. [19] EPELMAN SI,MANN DL.Communication in the heart:the role of the innate immune system in coordinating cellular responses to ischemic injury[J].J Cardiovasc Transl Res,2012,5(6):827. -
点击查看大图
计量
- 文章访问数: 4195
- HTML全文浏览量: 756
- PDF下载量: 37
- 被引次数: 0
下载:
