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目的探讨重组人脑利钠肽治疗老年急性心肌梗死合并左心功能衰竭的疗效及安全性。方法选取老年急性心肌梗死合并左心功能衰竭患者46例,随机分为两组,治疗组在常规治疗基础上静脉泵入重组人脑利钠肽(先以负荷剂量1.5~2.0μg/kg静推,再予维持剂量0.007 5~0.01μg/kg.min持续泵入);对照组在常规治疗基础上静点硝酸甘油(起始剂量为5~10μg/min,每隔5~10min增加5~10μg/min,直至获满意效果),共用3d。观察两组患者用药前后血压、心率、尿量及血氧饱和度变化,并测量左室射血分数(LVEF)、左室短轴缩短率(FS)、心脏指数(CI)、二尖瓣舒张期E峰和A峰的比值(E/A)。结果在降低血压、心率,增加尿量方面两组差异有统计学意义(P<0.05);治疗组用药后左室收缩指标(EF、CI)和舒张功能指数(E/F)较对照组明显改善(P<0.05);治疗组药物不良反应发生率9.1%,对照组41.7%,差异具有统计学意义(P<0.05)。结论重组人脑利钠肽治疗老年急性心肌梗死合并左心功能衰竭疗效显著,安全性好,不良反应发生率低。
Objective To investigate the efficacy and safety of recombinant human brain natriuretic peptide in the treatment of senile acute myocardial infarction complicated with left heart failure. Methods Forty-six elderly patients with acute myocardial infarction complicated with left heart failure were randomly divided into two groups. Patients in the treatment group received intravenous infusion of recombinant human brain natriuretic peptide (conventional intravenous injection at a loading dose of 1.5-2.0 μg / kg , And then to maintain the dose of 0.007 5 ~ 0.01μg / kg.min continuous pump); control group on a routine basis based on the nitroglycerin (initial dose of 5 ~ 10μg / min, every 5 ~ 10min increase 5 ~ 10μg / min, until satisfied), share 3d. The changes of blood pressure, heart rate, urine output and blood oxygen saturation were observed before and after treatment. The left ventricular ejection fraction (LVEF), left ventricular fractional shortening (FS), cardiac index (CI), mitral diastolic The ratio of peak E to peak A (E / A). Results There was significant difference between the two groups in reducing blood pressure, heart rate and increasing urine output (P <0.05). The EF, CI and E / F of the treatment group were significantly higher than those of the control group (P <0.05). The adverse drug reaction rate in the treatment group was 9.1% and that in the control group was 41.7%, the difference was statistically significant (P <0.05). Conclusion The recombinant human brain natriuretic peptide is effective in treating elderly patients with acute myocardial infarction complicated with left heart failure. The safety is good and the incidence of adverse reactions is low.