重组人脑利钠肽对急性前壁心肌梗死合并心力衰竭患者左心功能及远期左室重构的影响

【目的】研究静脉应用重组人脑利钠肽(rhBNP)对经皮冠状动脉介入治疗(PCI)的急性心肌梗死合并心力衰竭患者左心功能和远期左室重构的影响。【方法】将60例首发急性前壁ST段抬高心肌梗死合并急性心力衰竭患者随机分为重组人脑利钠钛(rhBNP)治疗组和对照组,每组各30例患者。比较两组患者治疗24小时的心功能改善情况、呼吸困难程度、整体临床状况、尿量的变化。监测两组治疗前及治疗后24 h、48 h血浆NT-proBNP水平,以及治疗前及治疗后肾素、血管紧张素II、醛固酮水平。观察两组患者治疗后24 h、出院时及出院后6个月时心功能及左室重构变化。【结果】用药后24 h rhBNP组患者呼吸困难程度、尿量、尿量与入量的差值、EF值、Tei指数与对照组比较,差异有统计学意义(P<0.05);与对照组相比,治疗48h时,rhBNP组的血浆rhBNP、肾素、血管紧张素II及醛固酮水平下降更明显(P<0.05);两组患者好转出院时,左心室舒张末期容积(LVEDV)差异无显著性意义(P>0.05),而rhBNP组EF值及Tei指数较对照组明显升高(P<0.05);出院后6个月时,rhBNP组Tei指数、EF值较对照组仍明显升高(P<0.05),而rhBNP组LVEDV及△LVEDV%较对照组降低(P<0.05)。【结论】rhBNP能有效改善急性心肌梗死后心力衰竭患者的呼吸困难和临床状况,并且可以延缓远期心室重构,改善远期心功能。

Effects Recombinant Human Brain Natriuretic Peptide on ventricular fumction and future ventricular remodeling in patients with anterior wall acute myocardial infarction and heart failure

[ Objective ] To evaluate the influence of recombinant human brain natriuretic peptide （rhBNP） on ventricular function and future ventricular remodeling （LVR） in patients who undergone anterior wall acute myocardial infarction （AMI） and acute heart failure treated with percutaneous coronary intervention （PCI）. [ Methods ] 60 patients with acute anterior myocardial infarction and heart failure for the first time were randomly divided into rhBNP group and the control group, and each 30 cases.The improvement of cardiac function, difficulty breathing, the overall clinical condition and urine were compared between the two groups at 24h after treatment.The NT-proBNP level was measured at baseline and 24h, 48h after baseline.The plasma rennin, angiotensin II and aldosterone were measured at baseline and 48h after baseline. The echocardiogram was performed at 24h after drug infusion, discharge and after discharge 6th months, to observe the improvement of cardiac function and future ventricular remodeling. [Results] There were significant differences of the dyspnea, urine output, urine output and intake difference, EF, Tei index between the rhBNP group and the control group at 24h after treatment （ P 〈 0.05）.Compared with control group, rhBNP group showed a more decrease of the plasma NT-proBNP ,rennin, angiotensin II and aldosterone at 48h after treatment（ P 〈 0.05）. The LVEDV had no significant difference between the two groups, while the EF and Tei index were more increase in rhBNP group. At 6th months after discharge, the EF and Tei index were still higher than the control group （P 〈 0.05）, while the rhBNP group showed a more decrease of the LVEDV and △ LVEDV% （P 〈 0.05）. [ Conclusion ] rhBNP can improve the dyspnea and clinical conditions of the patients with heart failure after AMI and can further inhibit the remodeling of left ventricular and improve the left ventricular function.