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目的比较重组人脑利钠肤和硝普纳治疗失代偿性心力衰竭(心衰)的治疗效果、安全性,探讨重组人脑利钠钛对心脏细胞外基质的影响。为重组人脑利钠肤应用于心衰治疗提供依据。方法试验对入选的44例失代偿性心衰患者的临床资料采用随机、开放、平行对照方法进行采集和统计分析。入选患者随机分配为重组人脑利钠肤组和硝普纳组,分别在给药的0、15、30 min 和1、2、4、6、9、12、24 h 结束时测量记录治疗前后的收缩压、舒张压,心率,呼吸困难程度及临床状况。在用药前、用药后24 h、用药后1周行心彩超检查测定射血分数。试验组使用重组人脑利钠肽首先以1.5μg/kg 静脉冲击后,以0.0075μg/(kg·min)连续静脉滴注;对照组静脉持续滴注硝普纳。安全性评估采用用药过程中及用药后定期测量血压、心率,并对过程中所有不良事件进行记录。结果试验组于各时间点改善呼吸困难作用均好于对照组;试验组在用药过程中对血压的影响小于对照组;试验组的用药过程中24 h 液体入量少于对照组(P<0.05),试验组用药过程中24 h 液体出量大于对照组(P<0.05)。两组在改善用药后1周左室射血分数方面无显著差异。试验组与对照组不良反应发生率差异无显著性意义(P=0.38)。用药后7 d 病死率,30 d 病死率两组差异无显著性意义,用药后30 d 再住院率试验组显著低于对照组。结论重组人脑利钠肽能明显改善急性失代偿性心衰患者的血流动力学、呼吸困难程度及全身临床状况,可提高患者左室射血分数。静脉应用重组人脑利钠肽低血压等不良事件的发生率至少不高于硝普纳,可改善心衰患者预后。
Objective To compare the therapeutic effects and safety of recombinant human brain natriuretic peptide and sodium nitroprusside in the treatment of decompensated heart failure (CHF) and to explore the effect of recombinant human brain natriuretic peptide on the extracellular matrix of heart. To provide the basis for recombinant human brain sodium and sodium for heart failure treatment. Methods The clinical data of 44 patients with decompensated heart failure were collected and analyzed by randomized, open and parallel control methods. Patients were randomly assigned to receive recombinant human brain sodium and sodium nitrite skin group and the treatment group were measured at 0,15,30 min and 1, 2, 4, 6, 9, 12, 24 h at the end of recording treatment before and after treatment Systolic blood pressure, diastolic blood pressure, heart rate, degree of dyspnea and clinical status. Before medication, 24 h after treatment, 1 week after treatment, the heart color ultrasound examination to determine ejection fraction. The experimental group using recombinant human brain natriuretic peptide first 1.5μg / kg intravenous impact, continuous intravenous infusion of 0.0075μg / (kg · min); control group intravenous infusion of nitroprusside. Safety assessment Blood pressure and heart rate were measured regularly during and after medication, and all adverse events in the process were recorded. Results The improvement of dyspnea in the experimental group was better than that in the control group at each time point. The influence of the experimental group on the blood pressure was less than that of the control group during the course of medication; the liquid intake of the experimental group was less than that of the control group at 24 h ), The amount of liquid in the experimental group was higher than that in the control group (P <0.05). There was no significant difference between the two groups in improving left ventricular ejection fraction 1 week after treatment. There was no significant difference in the incidence of adverse reactions between the experimental group and the control group (P = 0.38). At 7 days after treatment, the case fatality rate and the 30-day mortality rate had no significant difference between the two groups. The rehospitalization rate at 30 days after treatment was significantly lower in the experimental group than in the control group. Conclusions Recombinant human brain natriuretic peptide can significantly improve hemodynamics, degree of dyspnea and general clinical status in patients with acute decompensated heart failure and improve left ventricular ejection fraction. Intravenous application of recombinant human brain natriuretic peptide hypotension and other adverse events at least not higher than the incidence of nitroprusside can improve the prognosis of patients with heart failure.