重组人脑利钠肽治疗慢性肺源性心脏病心力衰竭的效果观察

目的观察重组人脑利钠肽（rhBNP）治疗慢性肺源性心脏病（CPHD）心力衰竭的临床效果。方法对我院2010年1月至2011年12月住院的56例CPHD心力衰竭患者随机分为研究组和对照组，两组均给予吸氧、抗感染、营养支持及并发症治疗。研究组在此基础上给予rhBNP治疗，观察两组临床症状、体征及心、肺功能改善的情况。结果研究组肺动脉压治疗前、后分别为（39．7±6．2）、（26．5±3．8）mmHg，两者比较差异有统计学意义（t=14．992，P=0．000）；对照组肺动脉压治疗前、后分别为（38．4±5．1）、（31．5±4．5）mmHg，两者比较差异有统计学意义（t=9．378，P=0．000）；两组治疗后比较差异有统计学意义（t=-9．742，P=0．000）。研究组B型脑钠肽（BNP）治疗前、后分别为（873．0±12．9）、（382．0±11．4）ng／L，两者比较差异有统计学意义（t=353．627，P=0．000）；对照组BNP治疗前、后分别为（862．0±12．3）、（568．0±12．6）ng／L，两者比较差异有统计学意义（t=156．135，P=0．000）；两组治疗后比较差异亦有统计学意义（t=-103．490，P=0．000）。研究组治疗前、后左心室射血分数分别为（38±9）％、（65±8）％，两者比较差异有统计学意义（t=-23．056，P=0．000）；对照组治疗前、后左心室射血分数分别为（32±7）％、（47±5）％，两者比较差异有统计学意义（t=-16．485，P=0．000）；两组治疗后比较差异亦有统计学意义（t=18．308，P=0．000）。研究组24h尿量治疗前、后分别为（0．9±0．4）、（1．6±0．3）L，两者比较差异有统计学意义（t=-17．320，P=0．000）；对照组24h尿量治疗前、后分别为（0．9±0．2）、（1．0±0．6）L，两者比较差异有统计学意义（t=-5．250，P=0．000）；两组治疗后比较差异亦有统计学意义（t=6．592，P=0．000）。研究组总有效率为82．2％（23／28），对照组总有效率为57．1％（16／28），两组比较差异有统计学意义（x2=4．139，P〈0．05）。结论rhBNP能有效改善CPHD心力衰竭患者的心功能。

Clinical effct of nesiritide therapy for chronic pulmonary heart disease heart failure research

Objective To investigate the clinical effect of heart failure recombinant human brain natriuretic peptide （rhBNP） in treatment of chronic pulmonary heart disease （ CPHD）. Methods Fifty-six CPHD patients with heart failure were randomly divided into control and research group who were hospitalized from January 2010 to December 201 t. Patient in two groups were given oxygen, anti-infection, nutritional support and complications treatment. In addition patients in the treatment group was treated with rhBNP. Clinical symptoms, signs and cardiac, pulmonary function of two groups were recorded. Results The pulmonary artery pressure in treatment group were （39. 7 ± 6. 2） mm Hg and （26. 5 ± 3.8） mm Hg before and after treatment, and the difference was significant（ t = 14. 992 ,P =0. 000）. The pulmonary artery pressure in control group were （ 38.4 ± 5.1 ） mm Hg and （31.5 ± 4. 5 ） mm Hg before and after treatment, and significant difference were seen （9. 378, P = 0. 000）. In addition, pulmonary artery pressure were different between in treatment and control group（t = -9. 742,P =0. 000）. The level of BNP in treatment group was （873.0 ± 12.9） ng/L and （382. 0± 11.4 ） ng/L, there was significant difference （ t = 353. 627, P = 0. 000 ） ; While in control group, the level of BNP was （862. 0 ±12. 3 ） ng/L and （568.0 ± 12. 6 ） ng/L before and after treatment, and the difference was significant（ t = 156. 135 ,P = 0. 000）. And there was sinificant difference between the two groups after treatment （t = - 103.490,P = 0. 000）. The left ventricular ejection fraction before and after treatment in treatment group was （38 ±9 ） % and （65 ± 8 ） %, and the difference was significant （ t = - 23. 056, P = 0. 000） ; While in control group,the Left ventricular ejection fraction was（ 32 ± 7 ） % and （47± 5 ） % before and after treatment, and the difference was significant （t = - 16. 485, P = 0. 000）. And the difference between two groups was significant（ t = 18.308,P〈0.01）.24 h urine volume in treatment group was （0.9 ±0.4） L and （1.6 ±0.3） L before and after treatment, and the difference was significant （ t = - 17. 320, P = 0. 000 ） ; While in control group, 24 h urine volume was（0. 9 ± 0. 2） L and （ 1.0 ±0. 6） L before and after treatment, and the difference was significant （ t = - 5. 250, P = O. 000）. And the difference between two groups was significant （ t = 6. 592, P = 0. 000 ）. The total effective rate in treatment was 82. 2% （23/28） ,higher than that in the control group （57.1% （16/28）, and the difference was significant（ X2 = 4. 139, P 〈 O. 05 ）. Conclusion rhBNP can improve heart function of CPHD patients with heart failure.