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目的探讨重组人脑利钠肽(rh BNP)对急性心衰患者血浆脑利钠肽(BNP)、去甲肾上腺素(NE)及心功能的影响。方法将108例急性心力衰竭患者随机分为rh BNP组和对照组各54例。观察两组治疗后血浆BNP及NE水平、心功能及临床疗效。结果rh BNP组治疗后血浆BNP、NE水平较对照组下降更明显(P<0.05)。rh BNP组左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室舒张末期容量(LVEDV)及左室收缩末期容量(LVESV)均较治疗前明显改善(P<0.05)。除LVESD外,rh BNP组各指标改善程度均优于对照组(P<0.05)。治疗2周后rh BNP组心功能改善的总有效率为90.7%,明显高于对照组75.9%的总有效率(P<0.05)。治疗后1年内rh BNP组心脏不良事件发生率(16.7%)低于对照组(40.70%),差异有统计学意义(P<0.05)。结论 rh BNP能有效地拮抗急性心衰患者BNP、NE等神经-内分泌激素的过度激活,明显改善患者的心功能状况。
Objective To investigate the effects of recombinant human brain natriuretic peptide (rh BNP) on plasma brain natriuretic peptide (BNP), norepinephrine (NE) and cardiac function in patients with acute heart failure. Methods 108 patients with acute heart failure were randomly divided into rh BNP group and control group of 54 cases. The plasma BNP and NE levels, cardiac function and clinical efficacy were observed after treatment. Results The levels of plasma BNP and NE in rhBNP group were significantly lower than those in control group (P <0.05). Left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) in rhBNP group were significantly improved than those before treatment (P <0.05). Except for LVESD, the indexes of rh BNP group were better than those of control group (P <0.05). After 2 weeks of treatment, the total effective rate of heart function improvement in rhBNP group was 90.7%, which was significantly higher than that of the control group (75.9%, P <0.05). The incidence of cardiac adverse events (16.7%) in rhBNP group was lower than that in control group (40.70%) after 1 year of treatment, the difference was statistically significant (P <0.05). Conclusion rh BNP can effectively antagonize the over-activation of neuroendocrine hormones such as BNP and NE in patients with acute heart failure, and significantly improve the cardiac function of patients.