重组人脑利钠肽与左西孟旦联合治疗急性心力衰竭的疗效

doi:10.3760/cma.j.issn.1007-1245.2024.22.022

摘要/Abstract

摘要：

目的　探讨重组人脑利钠肽与左西孟旦联合治疗急性心力衰竭的疗效及对患者心功能恢复、生活质量的影响。方法　运用随机盲选法，选取2023年2月至2023年7月郑州市第七人民医院心血管内科接诊的60例急性心力衰竭患者为对照组；2023年8月至2024年2月接诊的60例急性心力衰竭患者为研究组。对照组男29例，女31例，年龄（67.91±2.63）岁，发病至就诊时间（4.48±0.47）h，美国纽约心脏病协会（NYHA）心功能分级：Ⅱ级14例、Ⅲ级40例、Ⅳ级6例。研究组男22例，女38例，年龄（67.12±2.84）岁，发病至就诊时间（4.91±0.42）h，NYHA心功能分级：Ⅱ级15例、Ⅲ级36例、Ⅳ级9例。对照组在常规对症治疗基础上接受左西孟旦注射液治疗，静脉滴注，初始负荷剂量12 µg/kg，用药10 min后，按照0.1 µg/（kg·min）持续输注。研究组在对照组治疗基础上加用重组人脑利钠肽治疗，静脉滴注，初始负荷剂量1.5 µg/kg，用药2 min后，按照0.01 µg/（kg·min）持续输注。两组患者均于早餐后30 min给药，每日1次。72 h后评估疗效。两组患者出院后持续予以吸氧、利尿、扩张血管等维持治疗2个月。对比两组临床疗效、心功能［左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、心率（HR）、心脏指数（CI）］、血清学指标［乳酸（LA）、肌钙蛋白（CTnT）、N末端B型利钠肽前体（NT-ProBNP）］、生活质量［中国心血管病人生活质量评定问卷（CQQC）］及不良反应发生情况。采用χ²检验、t检验。结果　研究组治疗总有效率高于对照组［95.00%（57/60）比83.33%（50/60）］，差异有统计学意义（χ²=4.227，P=0.040）。治疗72 h、2个月后，研究组患者的LVEDD、LVEF、HR、CI分别为（54.26±3.82）mm、（53.15±3.24）mm、（53.23±3.57）%、（55.28±3.69）%、（72.31±6.04）次/min、（71.19±5.86）次/min、（3.82±0.34）L/（min·m²）、（3.94±0.41）L/（min·m²），对照组分别为（56.11±4.06）mm、（55.17±4.12）mm、（48.75±3.29）%、（51.34±3.37）%、（79.62±7.18）次/min、（76.22±6.34）次/min、（3.38±0.28）L/（min·m²）、（3.42±0.32）L/（min·m²）；研究组患者的LA、CTnT、NT-ProBNP水平分别为（1.83±0.65）mmol/L、（1.75±0.43）mmol/L、（0.10±0.04）µg/L、（0.07±0.02）µg/L、（5.12±0.52）µg/L、（4.28±0.67）µg/L，对照组分别为（2.39±0.72）mmol/L、（2.04±0.39）mmol/L、（0.18±0.05）µg/L、（0.11±0.03）µg/L、（7.58±0.89）µg/L、（6.69±0.98）µg/L，差异均有统计学意义（均P<0.05）。研究组患者CQQC的体力状况、医疗状况、一般生活、社会与心理状况、工作状况评分均高于对照组，病情维度评分低于对照组，差异均有统计学意义（均P<0.05）。两组不良反应发生率差异无统计学意义（P>0.05）。研究组2个月内再住院率低于对照组［3.33%（2/60）比13.33%（8/60）］，差异有统计学意义（χ²=3.927，P=0.048）。结论　应用左西孟旦、重组人脑利钠肽协同治疗急性心力衰竭患者，疗效理想，可促进患者心功能恢复，改善其血清学指标，提升患者生活质量。

关键词:

急性心力衰竭, 左西孟旦, 重组人脑利钠肽, 心功能, 生活质量

Abstract:

Objective　To explore the efficacy of the combination of recombinant human brain natriuretic peptide and levosimendan on acute heart failure and the effects on patients' cardiac function recovery and quality of life. Methods　A total of 60 patients with acute heart failure admitted to the Department of Cardiovascular Medicine, Zhengzhou Seventh People's Hospital from February 2023 to July 2023 were selected as the control group by random blind selection method; 60 patients with acute heart failure admitted from August 2023 to February 2024 were selected as the study group. In the control group, there were 29 males and 31 females, aged (67.91±2.63) years, the time from onset to treatment was (4.48±0.47) h, and the cardiac functional classification of New York Heart Association (NYHA) was as follows: grade Ⅱ in 14 cases, grade Ⅲ in 40 cases, and grade Ⅳ in 6 cases. In the study group, there were 22 males and 38 females, aged (67.12±2.84) years, the time from onset to treatment was (4.91±0.42) h, and the NYHA cardiac functional classification was grade Ⅱ in 15 cases, grade Ⅲ in 36 cases, and grade Ⅳ in 9 cases. On the basis of conventional symptomatic treatment, the control group received levosimendan injection with an initial load dose of 12 µg/kg and continued infusion at 0.1 µg/(kg·min) after 10 min of administration. On the basis of the control group, the study group was treated with recombinant human brain natriuretic peptide by intravenous infusion at an initial load dose of 1.5 µg/kg and continued infusion at 0.01 µg/(kg·min) after 2 min of administration. Both groups were administered 30 min after breakfast, once a day. The therapeutic effect was evaluated after 72 h. After discharge, the patients in both groups continued to receive maintenance treatment such as oxygen inhalation, diuresis, and vasodilation for 2 months. The clinical efficacy, cardiac function [left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), heart rate (HR), and cardiac index (CI)], serological indexes [lactic acid (LA), troponin (CTnT), N-terminal B-type natriuretic peptide precursor (NT-ProBNP)], quality of life [Chinese Questionnaire on the Quality of Life Assessment of Cardiovascular Patients (CQQC)], and occurrence of adverse reactions were compared between the two groups. χ² test and t test were used. Results　The total effective rate of the study group was higher than that of the control group [95.00% (57/60) vs. 83.33% (50/60)], with a statistically significant difference (χ²=4.227, P=0.040). After 72 hours and 2 months of treatment, the LVEDD, LVEF, HR, and CI in the study group were (54.26±3.82) mm, (53.15±3.24) mm, (53.23±3.57)%, (55.28±3.69)%, (72.31±6.04) beats/min, (71.19±5.86) beats/min, (3.82±0.34) L/(min·m²), and (3.94±0.41) L/(min·m²), and those in the control group were (56.11±4.06) mm, (55.17±4.12) mm, (48.75±3.29)%, (51.34±3.37)%, (79.62±7.18) beats/min, (76.22±6.34) beats/min, (3.38±0.28) L/(min·m²), and (3.42±0.32) L/(min·m²); the levels of LA, CTnT, and NT-ProBNP in the study group were (1.83±0.65) mmol/L, (1.75±0.43) mmol/L, (0.10±0.04) µg/L, (0.07±0.02) µg/L, (5.12±0.52) µg/L, and (4.28±0.67) µg/L, and those in the control group were (2.39±0.72) mmol/L, (2.04±0.39) mmol/L, (0.18±0.05) µg/L, (0.11±0.03) µg/L, (7.58±0.89) µg/L, and (6.69±0.98) µg/L, with statistically significant differences (all P<0.05). The scores of physical status, medical condition, general life, social and psychological condition, and work condition dimensions of the CQQC in the study group were higher than those in the control group, and the score of disease dimension was lower than that in the control group, with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). The re-hospitalization rate within 2 months in the study group was lower than that in the control group [3.33% (2/60) vs. 13.33% (8/60)], with a statistically significant difference (χ²=3.927, P=0.048). Conclusion　The efficacy of acute heart failure applied with levosimendan and recombinant human brain natriuretic peptide synergistically is ideal, which can promote the recovery of patients' cardiac function, improve their serological indexes, and enhance the patients' quality of life.

Key words:

Acute heart failure, Levosimendan, Recombinant human brain natriuretic peptide, Heart function, Quality of life

杨冠旭赵育洁李连东杨小溪杨毅博陈金福.

重组人脑利钠肽与左西孟旦联合治疗急性心力衰竭的疗效 [J]. 国际医药卫生导报, 2024, 30(22): 3801-3806.

Yang Guanxu, Zhao Yujie, Li Liandong, Yang Xiaoxi, Yang Yibo, Chen Jinfu.

Effect of recombinant human brain natriuretic peptide combined with levosimendan in the treatment of acute heart failure [J]. International Medicine and Health Guidance News, 2024, 30(22): 3801-3806.

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