急性心力衰竭患者使用重组人脑钠肽前后Ptf V1变化及临床意义

目的床旁心电图检测急性心力衰竭（心衰）患者使用重组人脑钠肽（新活素）前后心电图V1导联P波终末电势（Ptf V1）的变化及临床意义。方法 407例心功能≥Ⅲ级的急性心衰患者（其中冠心病197例,高血压性心脏病110例,心肌病55例,心脏瓣膜病45例）,先床边检测心电图,测量Ptf V1,再给新活素强心治疗（首先以1.5μg.kg-1静脉冲击后,以0.007 5μg.kg-1.min-1的速度连续静脉滴注,每日维持18h,以5～7d为一疗程）,在心功能改善达1级以上后,再床边复查心电图,测量Ptf V1,比较Ptf V1的变化。同时采用美国产GE vivi7超声仪分别于治疗前、后测定患者的射血分数（EF）、心脏指数（CI）、早期血流峰值速度（E）、晚期血流峰值速度（A）及E峰与A峰比例（E/A）。结果所有心衰患者治疗后,EF、CI、E/A等反映心功能的指数显著改善（P〈0.05或P〈0.01）,Ptf V1值负值明显变小（P〈0.05或P〈0.01）,与心功能改变一致。结论观察Ptf V1值的变化,对临床评价新活素治疗心衰的疗效及转归有重要的临床意义和实用价值。

Changes in Ptf V1 before and after Using Recombinant Human Brain Natriuretic Peptide and Their Clinical Significance in Patients with Acute Heart Failure

ObjectiveTo observe the changes in P terminal force in lead V1（Ptf V1） before and after using recombinant human brain natriuretic peptide（BNP） by bedside ECG monitoring and to investigate their clinical significance in patients with acute heart failure.MethodsThe Ptf V1 was measured by bedside ECG monitoring in 407 patients with acute heart failure（NYHA class Ⅲ-Ⅳ）,including 197 patients with coronary heart disease,110 patients with hypertensive heart disease,55 patients with cardiomyopathy and 45 patients with valvular heart disease.These patients were treated with intravenous pulse of 1.5 μg·kg-1recombinant human BNP,followed by continuous intravenous infusion of 0.007 5 μg·kg-1·min-1recombinant human BNP.The course of treatment was 5-7 days（18 hours per day）.After cardiac function was improved to NYHA class Ⅰ,the changes in Ptf V1 were observed and the parameters,including ejection fraction（EF）,cardiac index（CI）,early peak flow velocity,late peak flow velocity（A） and ratio of E peak to A peak（E/A） were determined by GE vivi7 ultrasound system.ResultsAfter treatment with recombinant human BNP,EF,CI and E/A were significantly improved and negative value of Ptf V1 was significantly decreased（P0.05 or 0.01）.ConclusionThe observation of changes in Ptf V1 has clinical and practical significance for assessing the effects of recombinant human BNP on acute heart failure.