重组人脑利钠肽在急性心肌梗死患者冠脉搭桥术后的应用分析

目的评价重组人脑利钠肽在急性心肌梗死患者行冠脉搭桥手术后应用的疗效。方法选择20例急性心肌梗死后2周左室射血分数50%且血浆(B型脑钠肽前体N末端)NT-proBNP400pg/ml拟行体外循环下冠脉搭桥手术患者入组,随机分为2组,试验组10例术后在常规治疗基础上加用重组人脑利钠肽治疗,对照组10例术后给予常规治疗,对比两组术后血流动力学、肾功能、超声心动图、血NT-proBNP、药物使用情况及住院时间等指标。结果对照组与试验组比较:术前左室舒张末径、射血分数、术前血清肌酐及肾小球滤过率差异均无统计学意义。本组均采用体外循环下冠脉搭桥手术治疗,术后观察血肌酐最大变化[(70.2±30.1)μmol/Lvs.(38.3±20.6)μmol/L,P0.05]、肾小球滤过率最大变化[(-53.7±12.1)ml/minvs.(-20.2±11.6)ml/min,P0.05]差异有统计学意义。术后24h尿量[(2231±769)mlvs.(2869±1082)ml,P0.05]、多巴胺使用时间[(9.3±3.2)dvs.(5.3±2.8)d,P0.05]、术后NT-proB-NP最大变化率[(410±168)%vs.(195±132)%,P0.05]、术后住院时间[(11.3±5.7)dvs.(8.7±3.8)d,P0.05]差异有统计学意义。结论重组人脑利钠肽能改善急性心梗病人急性期行体外循环冠脉搭桥手术后肾功能,缩短正性肌力药使用时间,缩短住院日。

Effects of postoperative nesiritide in patients with left ventricular dysfunction undergoing coronary artery bypass

Objective To evaluate the role of nesiritide in patient with left ventricular dysfunction undergoing coronary artery bypass using cardiopulmonary bypass. Methods Patients with history of acute myocardial infarction in 2 weeks and ejection fraction<50% and blood NT-proBNP>400 pg/ml who were undergoing CABG with CPB were randomly assigned for either nesiritide in addition to routine care or routine care alone. Postoperative renal function, drug prescribed and hospital stay length were assessed. Results Of 20 randomized patients, 10 received the study drug underwent CABG using CPB. Compared with routine care alone, nesiritide treatment was associated with a significantly attenuated peak increase in serum creatinine [(38.3±20.6)μmol/L vs. (70.2±30.1)μmol/L, P < 0.05] and a smaller fall in glomerular filtration rate[(-20.2±11.6)ml/min vs. (-53.7±12.1)ml/min, P < 0.05] during hospital stay. In addition, nesiritide-treated patients had a shorter use time of dopamine[(5.3±2.8)day vs. (9.3±3.2)day, P < 0.05] and shorter hospital stay[(8.7±3.8)day vs. (11.3± 5.7)day, P < 0.05]. Conclusions Nesiritide in the setting of CABG with CPB is associated with improved postoperative renal function and possibly enhance recovery.