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目的探讨重组人脑利钠肽(rh BNP)对慢性心力衰竭(CHF)患者自主神经功能的调节作用,为临床治疗提供参考依据。方法选取廊坊市第四人民医院心内科2013年1月至2015年3月住院治疗的76例CHF患者为研究对象,采用随机数字表法将患者分为对照组和rh BNP组,每组38例。在常规治疗基础上,对照组加用硝酸甘油(10μg·kg-1·min-1)治疗;而rh BNP组则加用rh BNP微泵治疗,采用1.500 0μg/kg的负荷剂量静脉推注,1~2 min后按0.007 5μg/kg的剂量维持治疗,并依据血压和心率变化情况调整给药速度,连续静脉输入72 h,观察血液动力学和心功能指标变化情况。应用SPSS 13.0统计软件对数据进行t检验和χ2检验。结果两组治疗后心率、左心室射血分数(LVEF)、左室收缩末期内径(LVESD)均有改善;而rh BNP组改善程度优于对照组,差异均有统计学意义(P<0.05)。rh BNP组治疗后全程NN间期的标准差(SDNN)、全程每5 min NN间期平均值的标准差(SDANN)、全部相邻NN之差的均方根(RMSSD)和相邻NN之差>50ms的个数占总窦性心搏个数的百分率(PNN50)及震荡斜率(TS)显著高于对照组,而震荡初始(TO)则显著低于对照组,差异均有统计学意义(P<0.05)。结论短期灌注rh BNP可明显改善CHF患者心功能状况,并对CHF患者自主神经功能起到一定的调节作用。
Objective To investigate the regulatory effect of recombinant human brain natriuretic peptide (rh BNP) on autonomic nervous system function in patients with chronic heart failure (CHF), and to provide a reference for clinical treatment. Methods A total of 76 CHF patients hospitalized from January 2013 to March 2015 in the Department of Cardiology of the Fourth People’s Hospital of Langfang City were enrolled and divided into control group and rhBNP group by random number table method, . On the basis of routine treatment, the control group was treated with nitroglycerin (10μg · kg-1 · min-1), while the rh BNP group was treated with rh BNP micropumps. The rats were intravenously injected with a loading dose of 1.500 μg / kg, After 1 ~ 2 min, the patients were treated with 0.007 5 μg / kg. The speed of drug administration was adjusted according to the changes of blood pressure and heart rate. The rats were given 72-hour continuous intravenous infusion to observe the change of hemodynamics and cardiac function. SPSS 13.0 statistical software was used to perform t-test and χ2 test on the data. Results The heart rate, left ventricular ejection fraction (LVEF) and left ventricular end-systolic diameter (LVESD) were improved in both groups after treatment. The improvement of rhBNP group was better than that of the control group (P <0.05) . The mean standard deviation (SDNN), the standard deviation (SDANN), the average standard deviation (SDANN), the root mean square error (RMSSD) of all adjacent NNs, The percentage of total sinus beats (PNN50) and concussion slope (TS) were significantly higher than those of the control group (P> 50 ms), while the initial shock (TO) was significantly lower than that of the control group <0.05). Conclusion Short-term perfusion of rhBNP can significantly improve cardiac function in patients with CHF, and play an important role in the regulation of autonomic function in CHF patients.