冻干重组人脑利钠肽治疗老年急性非ST段抬高型心肌梗死合并急性左心衰竭的疗效

目的 观察重组人脑利钠肽治疗急性非ST段抬高型心肌梗死（non-ST-elevation myocardial infarction,NSTEMI）合并急性左心衰竭患者的临床疗效.方法 选择2011年1月至2012年11月天津市第一医院收治的46例年龄＞65岁的NSTEMI合并急性左心衰竭的患者为研究对象.分为试验组23例,以常规疗法＋重组人脑利钠肽（recombinant human brain natriuretic peptide,rhBNP）治疗；对照组23例,以常规疗法＋硝酸异山梨酯治疗.观察两组临床症状缓解情况,记录两组治疗前、后心功能Killip分级、心率、收缩压、血清脑利钠肽浓度、左心室射血分数、心脏指数、每搏输出量及入住重症监护病房时间,比较两组治疗效果.结果 在治疗24 h后两组临床症状均有改善,试验组总有效率高于对照组,差异有统计学意义86.9％（21/23）vs.65.2％（13/23）,P＜0.05].治疗7d后,两组患者的心脏指数、每搏输出量均有提高,且试验组改善更显著,与对照组比较,差异有统计学意义（3.09±0.53）L·min-1 ·m-2 vs.（2.69±0.33）L·min-1 ·m-2,P＜0.05;（54.94 ±5.58）mLvs.（52.10±5.20）mL,P＜0.05]；治疗7d后试验组N末端脑利钠肽前体、左心室射血分数显著优于对照组,差异有统计学意义（1863.59±366.87）pg· mL-1 vs.（2 336.64±518.44） pg· mL-1,P＜0.05;45.28％±5.49％ vs.40.62％±6.16％,P＜0.05].试验组入住重症监护病房时间及总住院时间明显少于对照组,差异有统计学意义（3.3±0.8）dvs.（4.5±1.6）d,P＜0.05;（8.2±1.2）d vs.（10.3±2.5）d,P＜0.05].结论 rhBNP能有效改善老年NSTEMI合并急性左心衰患者的临床症状及血流动力学参数,减少患者入住重症监护病房时间,无严重不良反应.

Clinical observation of recombinant human brain natriuretic peptide to treat elderly patients with acute non-ST-elevation myocardial infarction and acute left heart failure

Objectives To observe the effect and safety of recombinant human brain natriuretic peptide （rhBNP） in patients with non-ST-elevation myocardial infarction （NSTEMI） complicated by acute left heart failure （ALHF）.Methods Totally 46 patients aged over 65 with acute decompensated heart failure in the Geriatric department of intensive care unit （ICU） in The First Hospital of Tianjin from January 2011 to November 2012 were involved in this study.We randomly divided them into two groups：23 patients treated with common therapy and rhBNP （experiment group） and 23 patients treated with common therapy and isoket （control group）.Therapeutic effect and adverse effect of the two groups were analyzed and compared.The clinical status and laboratory data including cardiac function （Killip class）,heart rate,systolic blood pressure,levels of N-terminal pro-brain natriuretic peptide （NT-proBNP）,left ventricular ejection fraction （LVEF）,cardiac index （CI）,stroke volume （SV） and duration of ICU stay were observed before and after treatment in patients of the two groups.Results Both efficiency and total effective rate 24 h after treatment in experiment group were significantly higher than those in control group 86.9% （21/23） vs.65.2% （13/ 23）,P〈0.05].Both CI and SV improved after treatment for 7 d,and patients in experiment group were obviously better when compared with control group （3.09±0.53） L· min-1· m-2 vs.（2.69±0.33） L· min-1· m-2,P〈0.05 ; （54.94±5.58） mL vs.（52.10±5.20）mL,P〈0.05].Seven days after treatment,compared with those in control group,the levels of NT-proBNP and LVEF in experiment group significantly decreased （1 863.59±366.87） pg· mL-1 vs.（2 336.64±518.44） pg·mL-1,P〈0.05; 45.28%±5.49% vs.40.62%±6.16%,P〈0.05].Duration of ICU and in-hospital in experiment group was obviously less than those in control group （3.3±0.8）d vs.（4.5±1.6）d,P〈0.05; （8.2±1.2）d vs.（10.3±2.5）d,P〈0.05].Conclusions Intravenous injection ofrhBNP can significantly reduce NT-proBNP level and improve hemodynamic parameters and clinical symptoms in elderly patients with NSTEMI complicated by ALHF.