重组人脑钠肽与硝酸甘油治疗急性前壁心肌梗死合并失代偿性心力衰竭的疗效比较

目的比较重组人脑钠肽(rh BNP)与硝酸甘油治疗急性前壁心肌梗死(AAMI)合并失代偿性心力衰竭的疗效及安全性。方法选取2012年3月至2013年10月在驻马店市中心医院心内科CCU的AAMI合并失代偿性心力衰竭患者42例,男性29例,女性13例,年龄范围18~75岁。随机分为两组:脑钠肽组(20例)和硝酸甘油组(22例)。脑钠肽组在常规治疗基础上静脉泵入rh BNP;硝酸甘油组在常规治疗基础上静脉泵入硝酸甘油,均连续治疗72 h。两组患者治疗前后评定心功能分级,监测心率、血氧饱和度、72 h尿量等,检测左心室射血分数(LVEF)、左心室短轴缩短率(FS)、心脏指数(CI)、心输出量(CO)、二尖瓣血流舒张早期最大流速E峰与心房收缩期最大流速A峰的比值(E/A),并记录药物的不良反应,随访30 d内心血管不良事件情况。结果脑钠肽组总有效率高于硝酸甘油组(95.0%vs.63.6%),差异有统计学意义(P0.05)。脑钠肽组治疗开始后各时间点肺毛细血管楔压(PCWP)和肺动脉压(PAP)均低于硝酸甘油组,差异具有显著统计学意义(P均0.01)。治疗72 h后,与硝酸甘油组比较,脑钠肽组患者的心率、呼吸频率减少,血氧饱和度、72 h尿量增加,差异具有显著统计学意义(P均0.01);收缩压和呋塞米用量降低(P均0.05)。治疗72 h后,与硝酸甘油组比较,脑钠肽组患者的LVEF[(33.52±10.47)%vs.(46.86±11.32)%]、FS[(18.86±6.39)%vs.(22.40±6.55)%]、CI[(2.24±0.48)L/(min?m2)vs.(2.87±0.33)L/(min?m2)]、CO[(4.87±0.37)L/min vs.(5.16±0.42)L/min]、E/A[(0.85±0.17)vs.(0.93±0.19)]均升高,差异具有统计学意义(P均0.05)。脑钠肽组发生症状性低血压1例,硝酸甘油组发生头部胀痛7例,低血压1例。随访30 d内心血管不良事件,脑钠肽组心血管不良事件发生率明显低于硝酸甘油组(5%vs.45.5%,P0.05)。结论rh BNP能够降低PCWP、PAP,排钠利尿,改善血流动力学和心功能,减少心血管不良事件,不良反应较少,疗效与安全性优于硝酸甘油。

Comparison in curative effects between recombinant human brain natriuretic peptide and nitroglycerin in treatment of acute anterior myocardial infarction complicating acute decompensated heart failure

Objective To compare curative effect and safety between recombinant human brain natriuretic peptide （rhBNP） and nitroglycerin （NTG） in treatment of acute anterior myocardial infarction （AAMI） complicating acute decompensated heart failure （ADHF）.Methods The patients （n=42, male 29, female 13 aged from 18 to 75） were chosen from Mar. 2012 to Oct. 2013, and randomly divided into rhBNP group （n=20） and NTG group （n=22）. The rhBNP group was given rhBNP and NTG group was given NTG besides of routine therapies for 72 h continuously. The changes of heart function grading, heart rate （HR）, oxygen saturation （SpO2）, 72-h urine volume （72-h RUV）, left ventricular ejection fraction （LVEF）, left ventricular fraction shortening （LVFS）, cardiac index （CI）, cardiac output （CO） and E/A were detected, and adverse reactions were recorded in 2 groups before and after treatment. The adverse cardiovascular events within 30 d were followed up.Results The total effective rate was higher in rhBNP group than that in NTG group （95.0%vs. 63.6%,P〈0.05）. The levels of PCWP and PAP were lower in rhBNP group than those in NTG group at all time points （allP〈0.01）. After treatment for 72 h, HR and respiratory rate decreased and SpO2 and 72-h RUV increased （allP〈0.01）, and SBP and furosemide dose decreased （allP〈0.05） in rhBNP group compared with NTG group. After treatment for 72 h, LVEF [（33.52±10.47）%vs. （46.86±11.32）%], LVFS [（18.86±6.39）%vs. （22.40±6.55）%],CI [（2.24 ±0.48） L/（min·m^2）vs. （2.87±0.33） L/（min·m^2）], CO [（4.87±0.37） L/minvs. （5.16±0.42） L/min] and E/A [（0.85± 0.17）vs. （0.93±0.19） ] all increased in rhBNP group compared with NTG group （allP〈0.05）. In rhBNP group, there was 1 case with symptomatic hypotension, and in NTG group, there were 7 cases with headache and 1 with hypotension. The incidence of adverse cardiovascular events within 30 d was significantly lower in rhBNP group than tha