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目的探讨 B 型利钠肽(BNP)在慢性心力衰竭(CHF)患者的社区管理中应用的价值与作用。方法社区慢性心力衰竭病例123例,按心功能(NYHA)分级随机分为 BNP 监测组和对照组,进行定期动态BNP 监测,根据 BNP 水平指导合理调整治疗措施,随访监测达1年。结果与心衰的严重程度 BNP 浓度成正比。心功能Ⅲ～Ⅳ级者血浆 BNP 浓度均有不同程度升高,随着心功能衰竭程度的加重血浆 BNP 的浓度也随之升高。根据 BNP 浓度及时调整治疗方案加强社区管理。监测组患者与对照组再次住院率分别为20.63%、41.67%,心血管意外事件发生率分别为20.63%、40.00%,病死率分别为4.67%、16.67%,P 值均<0.05。结论在社区 CHF 患者动态监测 BNP 浓度,根据其浓度变化指导调节合理治疗方案加强社区管理,对降低CHF 的再次住院率、病死率、心血管意外事件发生率,改善预后有显著的作用。
Objective To investigate the value and role of B-type natriuretic peptide (BNP) in the community management of patients with chronic heart failure (CHF). Methods 123 cases of community-based chronic heart failure were randomly divided into BNP monitoring group and control group according to the NYHA classification. The BNP level was monitored regularly. The treatment was adjusted according to the level of BNP. The follow-up monitoring was performed for 1 year. The results were proportional to the severity of heart failure and BNP concentration. Plasma BNP levels in patients with cardiac function Ⅲ ~ Ⅳwere all increased to different degrees. With the increase of heart failure plasma BNP concentration also increased. According to BNP concentration timely adjustment of treatment programs to strengthen community management. The re-hospitalization rates of patients in monitoring group and control group were 20.63% and 41.67%, respectively. The incidences of cardiovascular accidents were 20.63% and 40.00% respectively. The mortality rates were 4.67% and 16.67%, respectively, with P values <0.05. Conclusions The dynamic monitoring of BNP concentration in community CHF patients and the adjustment of reasonable treatment regimen according to the changes of their concentrations can strengthen community management and have a significant effect on reducing the rate of rehospitalization, mortality, cardiovascular accidents and prognosis.