论文部分内容阅读
目的观察重组人脑利钠肽(recombinant human brain natriuretic peptide,rh BNP)在治疗合并心力衰竭的急性非ST抬高心肌梗死的老年患者的临床疗效。方法选择2013年6月至2014年3月在宣武医院综合科和心内科确诊为急性非ST抬高心肌梗死合并心力衰竭住院的高龄老年患者86例,男47例,女39例,平均年龄(79.63±4.41)岁。随机分为rh BNP治疗组(41例)及硝酸甘油对照组(45例),2组均给予常规治疗,治疗组在此基础上加用rh BNP,先给予1.5μg/kg负荷量,继之以0.01μg/(kg·min)静脉持续泵入72h。对照组在常规治疗基础上加用硝酸甘油10-15μg/min静脉持续泵入72h。2组均总治疗7d。分别对2组治疗前及治疗后48h、72h、7d收缩压、舒张压、心率、N末端B型利钠肽原(N terminal B type natriuretic peptide,NT-pro BNP)、左室射血分数(Left ventricular ejection fraction,LVEF)、左室舒张末期内径(Left ventricular end diastolic dimensio,LVEDD)、左室收缩末期内径(Left ventricular endsystolic volume,LVSDD)、每搏输出量(Stroke volume,SV)、心排血量(Cardiac output,CO)等指标进行检测。观察记录患者住院期间及出院后1个月6min步行试验(6 minutes walking test,6MWT),随访1个月内发生的不良心血管事件(Major adverse cardiacevents,MACE),包括恶性心律失常、再次心肌梗死以及死亡发生情况。结果治疗7d后rh BNP组收缩压、心率和NT-pro BNP与对照组比较明显下降(P<0.05)。rh BNP组治疗后左室射血分数(LVEF)、每搏输出量(SV)、心排血量(CO)均优于对照组(P<0.05),左室舒张末期内径(LVEDD)和左室收缩末期内径(LVSDD)较对照组显著降低(P<0.05)。rh BNP组患者6MWT大于对照组(P<0.05)。rh BNP组住院及出院后1个月内MACE明显低于对照组(P<0.05)。结论对老年急性非ST抬高心肌梗死并发心力衰竭患者常规治疗基础上加用rh BNP治疗,可进一步改善心功能,减少MACE。
Objective To observe the clinical efficacy of recombinant human brain natriuretic peptide (rh BNP) in elderly patients with acute non-ST-elevation myocardial infarction complicated with heart failure. Methods From June 2013 to March 2014, 86 elderly elderly patients admitted to Xuanwu Hospital General Hospital and Cardiology Department were enrolled in this study. There were 47 males and 39 females with average age ( 79.63 ± 4.41) years old. Randomly divided into rh BNP treatment group (n = 41) and nitroglycerin control group (n = 45). The two groups were given routine treatment. The treatment group was given rh BNP on the basis of 1.5 μg / kg loading, followed by A continuous intravenous infusion of 0.01μg / (kg · min) for 72h. Control group on the basis of conventional treatment plus nitroglycerin 10-15μg / min intravenous infusion of 72h. The two groups were treated for 7 days. The systolic blood pressure, diastolic blood pressure, heart rate, N terminal B type natriuretic peptide (NT-pro BNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), left ventricular end-systolic volume (LVSDD), stroke volume (SV) Cardiac output (CO) and other indicators were detected. The 6-minute walking test (6MWT) was recorded during hospitalization and 1 month after discharge. Major adverse cardia events (MACE), including malignant arrhythmia, recurrent myocardial infarction As well as the deaths. Results After 7 days of treatment, systolic blood pressure, heart rate and NT-pro BNP in rhBNP group were significantly decreased compared with those in control group (P <0.05). Left ventricular ejection fraction (LVEF), stroke volume (SV) and cardiac output (CO) in rh BNP group were significantly higher than those in control group (P <0.05), left ventricular end diastolic dimension (LVEDD) Ventricular end-systolic diameter (LVSDD) was significantly lower than the control group (P <0.05). 6MWT in rhBNP group was higher than that in control group (P <0.05). MACE in rh BNP group was significantly lower than that in control group within one month after hospitalization and discharge (P <0.05). Conclusion The addition of rhBNP to the elderly patients with acute non-ST-elevation myocardial infarction complicated with heart failure can further improve cardiac function and reduce MACE.