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目的探讨重组人脑利钠肽(rhBNP)对心力衰竭合并肾功能不全的临床疗效。方法以2011年3月至2015年3月廊坊市第四人民医院收治的56例慢性心力衰竭合并肾功能不全患者为研究对象,按照数字随机列表法将56例患者分为对照组和观察组,每组28例。所有患者均实施限水、限盐和利尿剂、血管转换酶抑制药物、β受体阻滞剂等基础治疗。对照组在基础治疗基础上静脉泵入硝普钠,观察组则加用rhBNP治疗。记录和监测治疗前、治疗72 h后收缩压(SBP)、舒张压(DBP)、心率(HR)、左室射血分数(LVEF)、脑利钠钛前体(NT-proBNP)、血清肌酐(Scr)、尿素氮(BUN)、胱抑素C(Cys-C)、尿酸(UA)等。观察两组临床疗效。结果治疗后两组SBP、DBP有所下降,但与治疗前比较差异无统计学意义(P>0.05)。治疗后两组HR、LVEF、NT-proBNP均有好转(P<0.05或P<0.01),观察组改善程度更显著。治疗后对照组Scr、BUN、Cys-C及UA水平有所下降,但与治疗前比较差异无统计学意义(P>0.05),而观察组Scr和Cys-C明显下降(P<0.05),但BUN和UA下降不明显(P>0.05)。治疗后观察组总有效率为89.3%,明显高于对照组的75.0%(P<0.05)。结论与传统常规用药硝普钠相比,rhBNP可明显改善慢性心衰合并肾功能不全患者的心肾功能,且起效更迅速,患者整体临床状况改善更明显。
Objective To investigate the clinical effect of recombinant human brain natriuretic peptide (rhBNP) on patients with heart failure and renal insufficiency. Methods Fifty-six patients with chronic heart failure and renal insufficiency admitted to the Fourth People’s Hospital of Langfang City from March 2011 to March 2015 were enrolled. Fifty-six patients were divided into control group and observation group according to the random number list method. 28 cases in each group. All patients were implemented water, salt and diuretics, angiotensin converting enzyme inhibitors, β-blockers and other basic treatment. The control group was treated with intravenous sodium nitroprusside on the basis of the basic treatment while the observation group was treated with rhBNP. The SBP, DBP, HR, LVEF, NT-proBNP and serum creatinine were recorded and monitored before treatment. (Scr), blood urea nitrogen (BUN), cystatin C (Cys-C), uric acid (UA) and so on. The clinical effects of two groups were observed. Results After treatment, SBP and DBP decreased in both groups, but there was no significant difference between before and after treatment (P> 0.05). After treatment, HR, LVEF and NT-proBNP in both groups improved (P <0.05 or P <0.01), and the improvement in the observation group was more significant. The levels of Scr, BUN, Cys-C and UA in the control group decreased after treatment, but there was no significant difference between before and after treatment (P> 0.05), while Scr and Cys-C in the observation group were significantly decreased However, the decrease of BUN and UA was not significant (P> 0.05). The total effective rate of the observation group after treatment was 89.3%, which was significantly higher than that of the control group (75.0%, P <0.05). Conclusion Compared with the conventional sodium nitroprusside, rhBNP can significantly improve the heart and kidney function in patients with chronic heart failure complicated with renal insufficiency, and the onset of more rapid, the overall clinical improvement in patients with more obvious.