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重组人脑利钠肽联合左西孟旦治疗急性失代偿性心力衰竭合并肾功能不全的临床观察
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| 篇名： | 重组人脑利钠肽联合左西孟旦治疗急性失代偿性心力衰竭合并肾功能不全的临床观察 |
| TITLE： | Analysis of Clinical Efficacy of Recombinant Human Brain Natriuretic Peptide Combined with Levosimendan in the Treatment of Acute Decompensated Heart Failure Complicated with Renal Insufficiency |
| 摘要： | 目的：观察重组人脑利钠肽（rhBNP）联合左西孟旦治疗急性失代偿性心力衰竭（ADHF）合并肾功能不全的效果和安全性。方法：选择2019年1－12月西南医科大学附属医院心内科收治住院的ADHF合并肾功能不全患者156例，按随机数字表法分为rhBNP组、左西孟旦组和联合用药组，每组52例。所有患者均接受常规治疗。在此基础上，rhBNP组患者予注射用重组人脑利钠肽[以1.5μg/kg静脉注射冲击治疗后，再以0.0075μg（/kg·min）静脉滴注24h]；左西孟旦组患者予左西孟旦注射液12.5mg[以6～12μg（/kg·min）静脉滴注1h后，再以0.1μg（/kg·min）静脉滴注23h]；联合用药组按各单药组方法联合用药。3组患者均持续治疗7d。观察3组患者治疗前后心功能指标[心率（HR）、左室射血分数（LVEF）、左室舒张末径（LVEDD）]、平均动脉压（MAP）、肺毛细血管楔压（PCWP）、肾功能指标[肾小球滤过率估计值（eGFR）、血肌酐（Scr）]以及血清胱抑素C（Cys-C）、N末端B型利钠肽前体（NT-proBNP）水平，并记录其临床疗效和不良反应发生情况。结果：rhBNP组患者有3例脱落，左西孟旦组有1例脱落，共有152例完成本研究。治疗前，3组患者心功能指标、MAP、PCWP、肾功能指标以及血清Cys-C、NT-proBNP水平比较，差异均无统计学意义（P＞0.05）。治疗后，3组患者HR、MAP、PCWP和血清NT-proBNP水平以及联合用药组患者血清Cys-C水平均较治疗前显著降低（P＜0.05），3组患者LVEF以及左西孟旦组和联合用药组患者eGFR、Scr水平均较治疗前显著升高（P＜0.05），且联合用药组上述指标水平均显著优于rhBNP组和左西孟旦组（P＜0.05）。联合用药组患者的总有效率为94.23％，显著高于rhBNP组（77.55％）和左西孟旦组（76.47％）（P＜0.05）；3组患者不良反应发生率组间比较差异无统计学意义（P＞0.05）。结论：rhBNP联合左西孟旦治疗ADHF合并肾功能不全可显著提高临床疗效，改善患者心肾功能，且不增加不良反应的发生。 |
| ABSTRACT： | OBJECTIVE：To observe the clinical effect and safety of recombinant human brain natriuretic peptide （rhBNP） combined with levosimendan in the treatment of acute decompensated heart failure （ADHF）complicated with renal insufficiency. METHODS：A total of 156 patients with ADHF complicated with renal insufficiency admitted to the Dept. of Cardiology in the Affiliated Hospital of Southwest Medical University during Jan.-Dec. 2019 were randomly divided into rhBNP group ，levosimendan group and combination group ，with 52 patients in each group. All patients received rountine treatment. On this basis ，rhBNP group was given rhBNP for injection [after 1.5 μg/kg intravenous pulse injection，intravenous dripping for 24 h with 0.007 5 μg（/ kg· min）]；leosimendan group was given Leosimendan injection 12.5 mg [intravenous dripping for 1 h with 6-12 μg（/ kg·min），then intravenous dripping for 23 h with 0.1 μg（/ kg·min）]. Combination group received drug combination according to the administration method of single drug group. Three groups received treatment for consecutive 7 d. Cardiac function indexes [heart rate （HR），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD）]，mean arterial pressure （MAP），pulmonary capillary pressure （PCWP），renal function indexes [estimated glomerular filtration rate （eGFR），serum creatinine （Scr）]，serum levels of cystatin C （Cys-c）and amino-terminal brain natriuretic peptide precursor （NT-proBNP）were observed in 3 groups before and after treatment. Clinical efficacy and the occurrence of ADR were recorded. RESULTS ：Three cases withdrew from the study in rhBNP group and 1 case in levosimendan group ；152 cases completed the study. Before treatment ，there was no statistical significance in cardiac function indexes ，MAP，PCMP，renal function indexes or serum levels of Cys-C and NT-proBNP among 3 groups（P＞0.05）. After treatment ，the HP ，MAP，PCWP and serum level of NT-proBNP in 3 group as well as serum level of Cys-C in combination group were decreased significantly （P＜0.05）；the LVEF in 3 group as well as the eGFR and Scr level in levosimendan group and combination group were significantly increased （P＜0.05），compared with before treatment ；above indexes of combination group were significantly better than those of rhBNP group and levosimendan group （P＜0.05）. Total effective rate of combination group was 94.23％ ，which was significantly higher than those of rhBNP group （77.55％）and levosimendan group （76.47％）（P＜0.05）. There was no significant difference in the incidence of ADR among 3 groups（P＞ 0.05）. CONCLUSIONS ：rhBNP combined with levosimendan in the treatment of ADHF complicated with renal insufficiency can significantly increase the clinical efficacy ，and improve cardiac and renal function but don ’t increase the incidence of ADR. |
| 期刊： | 2020年第31卷第21期 |
| 作者： | 陈功，杨方，魏刚，李小平，李明，张亚玲 |
| AUTHORS： | CHEN Gong，YANG Fang，WEI Gang，LI Xiaoping ，LI Ming，ZHANG Yaling |
| 关键字： | 重组人脑利钠肽；左西孟旦；急性失代偿性心力衰竭；肾功能不全；疗效；安全性 |
| KEYWORDS： | Recombinant human brain natriuretic peptide ； Levosimendan；Acute decompensated heart failure ； Renal |
| 阅读数： | 605 次 |
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