早期重组人脑利钠肽联合无创正压通气治疗急性失代偿性心力衰竭疗效观察

目的：探讨早期静脉注射冻干重组人脑利钠肽（rhBNP）联合无创正压通气治疗急性心力衰竭的临床疗效.方法：分析112例急性心力衰竭且行无创正压通气患者的病历资料,记录其年龄、性别、既往史、入院第1、2、3、5、7、10天N末端脑利钠肽前体（NT-proBNP）、氧合指数、无创正压通气时间等.根据患者是否使用rhBNP,分为药物组58例,对照组54例,比较2组患者NT-proBNP、氧合指数、无创正压通气时间.根据多因素回归分析结果,绘制拟合曲线,并分析NT-proBNP及氧合指数的单位时间内变化率与无创正压通气时间的相关性.结果：药物组患者单位时间内NT-proBNP下降水平、氧合指数的上升水平均高于对照组（P〈0.01）.多因素回归分析显示：年龄OR=1.174,95%CI（1.797,1.910）,P〈0.01]、NT-proBNP变化率OR=1.363,95%CI（1.936,2.358）,P〈0.05]、氧合指数变化率OR=2.088,95%CI（1.273,1.847）,P〈0.05]均与无创正压通气时间呈相关关系.进一步绘制NT-proBNP的变化率与无创正压通气时间的拟合曲线,提示存在线性相关关系（P〈0.05）,氧合指数的变化率与无创正压通气时间的拟合曲线亦提示存在线性相关关系（P〈0.05）.结论：早期静脉注射rhBNP联合无创正压通气治疗急性心力衰竭可以较快降低NT-proBNP水平,并使氧合指数上升,且缩短患者的无创正压通气时间,临床疗效快速安全,对于心力衰竭症状的改善均有明显作用.

Effect of early intravenous recombinant human brain natriuretic peptide combined with noninvasive positive pressure ventilation in the treatment of acute decompensated heart failure

Objective：To investigate the clinical effects of early intravenous infusion recombinant human brain natriuretic peptide （rhBNP） combined with noninvasive positive pressure ventilation（NIPPV） in the treatment of patients with decompensated acute heart failure. Methods：The clinical data including age, gender, past medical history, N-terminal pro-brain natriuretic peptide （NT-proBNP） at 1,2,3,5,7 and lO days after hospitalization, oxygenation index and the time of NIPPV of 112 patients with decompensated acute heart failure were retrospectively analyzed. All patients were divided into drug group and control group according to whether the rhBNP was used. NT-proBNP, oxygenation index and the time of NIPPV in two groups were compared. According to the results of multivariate regression analysis, the fitting curve were drawed, the relativity between the variance ratio of NT-proBNP and oxygenation index and the time of NIPPV were analyzed. Results：The falling NT-proBNP level and rising oxygenation index level in drug group were higher than those in control group（ P 〈 0.01 ）. Multivariate regression analysis showed that age odds ratio（OR） -- 1. 174,95% ,95% CI（ 1. 797 to 1. 910） ,P 〈 0.01 ] ,the variance ratio of NT-proBNP OR = 1. 363,95% CI（ 1. 936 to 2. 358 ）, P 〈 0.05 ] and the variance ratio of oxygenation index OR = 2. 088,95 % CI（ 1. 273 to 1. 847 ）, P 〈 0.05 ] were correlated to the time of NIPPV. The variance ratio of NT- pmBNP and oxygenation index ,and the time of NIPPV in fitting curve showed linear correlation （P 〈 O. 05）. Conclusions：Early intravenous infusion recombinant rhBNP combined with NIPPY in the treatment of patients with decompensated acute heart failure can decrease the level of NT-proBNP,increase oxygenation index and short the time of NIVPPV,which can obviously improve the outcome of the patients.