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目的评价重组人脑利钠肽在急性心肌梗死患者行冠脉搭桥手术后应用的疗效。方法选择20例急性心肌梗死后2周左室射血分数<50%且血浆(B型脑钠肽前体N末端)NT-proBNP>400pg/ml拟行体外循环下冠脉搭桥手术患者入组,随机分为2组,试验组10例术后在常规治疗基础上加用重组人脑利钠肽治疗,对照组10例术后给予常规治疗,对比两组术后血流动力学、肾功能、超声心动图、血NT-proBNP、药物使用情况及住院时间等指标。结果对照组与试验组比较:术前左室舒张末径、射血分数、术前血清肌酐及肾小球滤过率差异均无统计学意义。本组均采用体外循环下冠脉搭桥手术治疗,术后观察血肌酐最大变化[(70.2±30.1)μmol/Lvs.(38.3±20.6)μmol/L,P<0.05]、肾小球滤过率最大变化[(-53.7±12.1)ml/minvs.(-20.2±11.6)ml/min,P<0.05]差异有统计学意义。术后24h尿量[(2231±769)mlvs.(2869±1082)ml,P<0.05]、多巴胺使用时间[(9.3±3.2)dvs.(5.3±2.8)d,P<0.05]、术后NT-proB-NP最大变化率[(410±168)%vs.(195±132)%,P<0.05]、术后住院时间[(11.3±5.7)dvs.(8.7±3.8)d,P<0.05]差异有统计学意义。结论重组人脑利钠肽能改善急性心梗病人急性期行体外循环冠脉搭桥手术后肾功能,缩短正性肌力药使用时间,缩短住院日。
Objective To evaluate the efficacy of recombinant human brain natriuretic peptide in patients with acute myocardial infarction after coronary artery bypass grafting. Methods 20 patients with left ventricular ejection fraction <50% 2 weeks after acute myocardial infarction and NT-proBNP> 400 pg / ml plasma (type B BNP precursors) were enrolled in patients undergoing coronary artery bypass grafting , Were randomly divided into two groups, the experimental group of 10 patients were treated with recombinant human brain natriuretic peptide on the basis of routine treatment, the control group of 10 patients were given conventional treatment after surgery, compared the postoperative hemodynamics, renal function , Echocardiography, blood NT-proBNP, drug use and hospital stay and other indicators. Results The control group and the experimental group: preoperative left ventricular end-diastolic diameter, ejection fraction, preoperative serum creatinine and glomerular filtration rate were no significant difference. This group were treated with coronary artery bypass grafting under cardiopulmonary bypass. The maximal changes of serum creatinine were observed postoperatively [(70.2 ± 30.1) μmol / L vs (38.3 ± 20.6) μmol / L, P <0.05] The maximum change [(-53.7 ± 12.1) ml / min vs (-20.2 ± 11.6) ml / min, P <0.05] was statistically significant. The amount of urinary excretion [(2231 ± 769) mlvs. (2869 ± 1082) ml, P <0.05] and the duration of dopamine administration [(9.3 ± 3.2) d vs. 5.3 ± 2.8 days, The maximum rate of change of NT-proB-NP was (410 ± 168)% vs (195 ± 132)%, P <0.05, and the postoperative hospital stay was (11.3 ± 5.7) dvs. 0.05] The difference was statistically significant. Conclusions Recombinant human brain natriuretic peptide can improve the renal function of acute myocardial infarction patients after cardiopulmonary bypass coronary artery bypass surgery, shorten the time of inotropic medicine and shorten the hospitalization days.