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目的:探讨重组人脑利钠肽(rh-BNP)治疗老年急性左心衰竭的短期疗效与安全性。方法:105例老年急性左心衰竭患者分为对照组62例和观察组43例。所有患者均采用吸氧、强心、利尿等对症治疗,对照组给予静脉持续72 h泵入硝酸甘油,起始剂量10μg·min~(-1),每次增加5μg·min~(-1),直至达到临床效应。观察组给予rh-BNP,首次负荷剂量1.5μg·kg~(-1)iv,再以0.007 5μg·kg~(-1)·min~(-1)连续输注72 h。记录两组患者治疗前后呼吸困难及心功能情况、24 h总尿量、左心室射血分数(EF)、血浆B型利钠素肽(BNP)、6 min步行试验结果;安全性评估记录收缩压与舒张压、肌酐、血钾及血钠的变化,并对过程中所有不良事件进行记录。结果:治疗后,两组24 h总尿量、6 min步行试验距离、左室射血分数及血BNP等各项指标均较治疗前有明显改善(P<0.05),且观察组更优于对照组(P<0.05)。两组患者用药后收缩压、舒张压、血钠、血钾均较治疗前明显降低(P<0.05),血肌酐无明显变化(P>0.05)。观察组治疗后血钠明显低于对照组(P<0.05)。两组药品不良反应发生率差异无统计学意义(P>0.05)。结论:重组人脑利钠肽能明显改善老年急性左心衰竭患者的症状,疗效显著,安全性较高。
Objective: To investigate the short-term efficacy and safety of recombinant human brain natriuretic peptide (rh-BNP) in the treatment of senile acute left heart failure. Methods: A total of 105 elderly patients with acute left heart failure were divided into control group (62 cases) and observation group (43 cases). All patients were treated with symptomatic therapy such as oxygen, cardiac and diuretic. In the control group, nitroglycerin was pumped into the vein for 72 h, the initial dose was 10μg · min ~ (-1) and the dose of 5μg · min ~ (-1) Until the clinical effect is achieved. The observation group was given rh-BNP at the first dose of 1.5 μg · kg -1 iv for 72 h with 0.007 5 μg · kg -1 -1 min -1. The dyspnea and cardiac function, the total 24 h urine output, the left ventricular ejection fraction (EF), plasma BNP, 6-min walking test were recorded before and after treatment in both groups. The safety evaluation recorded the contraction Pressure and diastolic blood pressure, creatinine, potassium and serum sodium changes, and record all the adverse events in the process. Results: After treatment, the 24-hour total urine output, 6-minute walking distance, left ventricular ejection fraction and blood BNP were significantly improved (P <0.05), and the observation group was better than Control group (P <0.05). The systolic blood pressure, diastolic blood pressure, serum sodium and serum potassium in both groups were significantly lower than those before treatment (P <0.05), and there was no significant change in serum creatinine (P> 0.05). The observation group after treatment, serum sodium was significantly lower than the control group (P <0.05). There was no significant difference in the incidence of adverse drug reactions between the two groups (P> 0.05). Conclusion: Recombinant human brain natriuretic peptide can significantly improve the symptoms of elderly patients with acute left heart failure, with significant curative effect and high safety.