无创血流动力学监测评价心脉隆注射液和冻干重组人脑利钠肽治疗缺血性心力衰竭的临床效果
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摘要
目的通过无创血流动力学监测评价心脉隆注射液和冻干重组人脑利钠肽治疗缺血性心力衰竭的临床效果。方法选取2015年2月至2017年2月海南省三亚市人民医院收治的缺血性心力衰竭患者96例,按照随机数字表法分为对照组和观察组,各48例。对照组给予常规药物+冻干重组人脑利钠肽治疗;观察组给予常规药物+心脉隆注射液治疗,均治疗5 d。观察2组治疗前后无创心功能监测指标、N末端B型脑钠肽前体(NT-proBNP)、尿量、血尿酸、血钠水平及治疗过程中的不良反应。结果观察组治疗第5天左心室射血分数、治疗第4天和第5天心排血量、治疗第5天心排血指数高于对照组同时间[(0.52±0.08)%比(0.46±0.16)%、(3.24±0.44)L/min比(2.72±0.38)L/min、(3.36±0.45)L/min比(2.68±0.34)L/min、(2.8±0.6)L/(min·m~2)比(2.2±0.5)L/(min·m~2)],治疗第4天和第5天外周血管阻力、外周血管阻力指数高于对照组[(1 652±325)DS/cm~5比(1 546±320)DS/cm~5、(1 654±324)DS/cm~5比(1 510±310)DS/cm~5、(2 796±421)DS/(min~2·m~5)比(2 052±418) DS/(min~2·m~5)、(2 624±419)DS/(min~2·m~5)比(2 045±404)DS/(min~2·m~5)],差异均有统计学意义(均P<0.05)。治疗后,观察组NT-proBNP、血尿酸均低于对照组,尿量高于对照组,差异均有统计学意义(均P<0. 05)。所有患者治疗过程中未出现恶性心律失常、心力衰竭恶化、急性冠状动脉综合征等不良反应。结论在缺血性心力衰竭患者治疗过程中心脉隆注射液能够明显改善心脏射血功能、心排血量、心排血指数;而重组人脑利钠肽能明显降低患者的外周血管阻力。
Objective To investigate the clinical effects of Xinmailong injection and lyophilized recombinant human brain natriuretic peptide(rhBNP) on ischemic heart failure evaluated by non-invasive hemodynamic monitoring.Methods From February 2015 to February 2017, 96 patients with ischemic heart failure in Sanya People's Hospital were randomly divided into control group and observation group, with 48 cases in each group. On the basis of routine medication,the control group was treated with rhBNP and the observation group was treated with Xinmailong injection for 5 days. Non-invasive cardiac function indicators, N-terminal brain natriuretic peptide precursor(NT-proBNP), urine volume, serum uric acid, serum sodium and adverse reactions were analyzed.Results During treatment, left ventricular ejection fraction on the 5 th day, cardiac output on the 4 th and 5 th days, cardiac index on the 5 th day in observation group were significantly higher than those in control group[(0.52±0.08)% vs(0.46±0.16)%,(3.24 ±0.44) L/min vs(2.72 ±0.38) L/min,(3. 36 ±0.45) L/min vs(2. 68 ±0. 34)L/min,(2. 8 ±0. 6)L/(min ·m~2) vs(2. 2 ±0. 5)L/(min · m~2) ]; systemic vascular resistance and systemic vascular resistance index on the 4 th and 5 th days in observation group were significantly higher than those in control group[(1 652±325)DS/cm~5 vs(1 546± 320)DS/cms,(1 654±324)DS/cm~5 vs(1 510±310)DS/cm~5,(2 796±421)DS/(min~2· m~5) vs(2 052±418)DS/(min~2 · m~5),(2 624±419)DS/(min~2·m~5) vs(2 045±404) DS/(min~2·m~5) ](all P < 0.05). After treatment, NT-proBNP level and serum uric acid level in observation group were significantly lower and urine volume was higher than those in control group(all P <0. 05). No adverse reactions such as malignant arrhythmia, deterioration of heart failure and acute coronary syndrome occurred during treatment. Conclusion Xinmailong injection can significantly improve cardiac ejection, cardiac output and cardiac index, while lyophilized recombinant human brain natriuretic peptide can significantly reduce peripheral vascular resistance in the treatment of ischemic heart failure.
Objective To investigate the clinical effects of Xinmailong injection and lyophilized recombinant human brain natriuretic peptide(rhBNP) on ischemic heart failure evaluated by non-invasive hemodynamic monitoring.Methods From February 2015 to February 2017, 96 patients with ischemic heart failure in Sanya People's Hospital were randomly divided into control group and observation group, with 48 cases in each group. On the basis of routine medication,the control group was treated with rhBNP and the observation group was treated with Xinmailong injection for 5 days. Non-invasive cardiac function indicators, N-terminal brain natriuretic peptide precursor(NT-proBNP), urine volume, serum uric acid, serum sodium and adverse reactions were analyzed.Results During treatment, left ventricular ejection fraction on the 5 th day, cardiac output on the 4 th and 5 th days, cardiac index on the 5 th day in observation group were significantly higher than those in control group[(0.52±0.08)% vs(0.46±0.16)%,(3.24 ±0.44) L/min vs(2.72 ±0.38) L/min,(3. 36 ±0.45) L/min vs(2. 68 ±0. 34)L/min,(2. 8 ±0. 6)L/(min ·m~2) vs(2. 2 ±0. 5)L/(min · m~2) ]; systemic vascular resistance and systemic vascular resistance index on the 4 th and 5 th days in observation group were significantly higher than those in control group[(1 652±325)DS/cm~5 vs(1 546± 320)DS/cms,(1 654±324)DS/cm~5 vs(1 510±310)DS/cm~5,(2 796±421)DS/(min~2· m~5) vs(2 052±418)DS/(min~2 · m~5),(2 624±419)DS/(min~2·m~5) vs(2 045±404) DS/(min~2·m~5) ](all P < 0.05). After treatment, NT-proBNP level and serum uric acid level in observation group were significantly lower and urine volume was higher than those in control group(all P <0. 05). No adverse reactions such as malignant arrhythmia, deterioration of heart failure and acute coronary syndrome occurred during treatment. Conclusion Xinmailong injection can significantly improve cardiac ejection, cardiac output and cardiac index, while lyophilized recombinant human brain natriuretic peptide can significantly reduce peripheral vascular resistance in the treatment of ischemic heart failure.
引文
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[6]吴迪,姚克纯,李利,等.应用心肌声学造影评价冠状动脉血运重建术心肌灌注[J].中国超声医学杂志,2013,29(4):338-341. DOI:10.3969/j. issn. 1002-0101.2013.04.017.Wu D, Yao KC, Li L, et al. The value of myocardial contrast echocardiography(MCE)for myocardial blood flow analysis in follow-up ischemic heart disease after coronary artery revaracularation[J].Chinese Journal of Ultrasound in Medicine, 2013,29(4):338-341. DOI:10.3969/j.issn. 1002-0101.2013.04.017.
[7] Perkins RE, Hollingsworth KG, Eggett C, et al. Relationship between bioreactance and magnetic resonance imaging stroke volumes[J]. Br J Anaesth, 2016,117(1):134-136. DOI:10.1093/bja/aew164.
[8] Aoka Y, Hagiwara N, Kasanuki H, et al. Heterogeneity of hemodynamic pa-rameters in untreated primary hypertension, and individualiza-tion of antihypertensive therapy based on noninvasive hemody-namic measurements[J]. Clin Exp Hypertens, 2013,35(1):61-66. DOI:10.3109/10641963.2012.690469.
[9]姚恩辉,李世春,王华军.心脉隆注射液对慢性心力衰竭患者心功能及血浆B型钠尿肽的影响[J].中国全科医学,2014,17(27):3239-3241. DOI:10.3969/j. issn. 1007-9572.2014.27.020.Yao EH, Li SC, Wang HJ. Effects of Xinmailong injection on cardiac function and plasma BNP level in the patients with chronic heart failure[J]. Chinese General Practice, 2014,17(27):3239-3241. DOI:10.3969/j.issn. 1007-9572.2014.27.020.
[10]张忠晶,曹兵,倪伟.心脉隆干预治疗对慢性心功能不全患者心率减速力水平的影响[J].实用药物与临床,2018,21(2):157-160. DOI:10.14053/j.cnki.ppcr.201802008.Zhang ZJ, Cao B, Ni W. Influence of Xinmailong on deceleration capacity in patients with chronic heart failure[J]. Practical Pharmacy and Clinical Remedies, 2018,21(2):157-160. DOI:10.14053/j. cnki. ppcr. 201802008.
[11]李宏丽,王小艳,石卉,等.心力衰竭新标记物临床研究进展[J].心脏杂志,2014,26(4):484486,490.DOI:10.13191/j. chj. 2014.0063.Li HL, Wang XY, Shi H, et al. Clinical research progress in novel biomarkers of heart failure[J]. Chinese Heart Journal,2014,26(4):484-486,490. DOI:10.13191/j. chj.2014.0063.
[12]张慧颖,郝艳丽,李延辉,等.重组人脑利钠肽对老年急性失代偿心力衰竭患者的疗效及预后分析[J].疑难病杂志,2017,16(4):340-343. DOI:10.3969/j. issn. 1671-6450.2017.04.005.Zhang HY, Hao YL, Li YH, et al. Efficacy and prognosis of recombinant human brain natriuretic peptide in elderly patients with acute decompensated heart failure[J]. Chinese Journal of Difficult and Complicated Cases, 2017,16(4):340-343. DOI:10.3969/j. issn. 1671-6450.2017.04.005.
[2]王馨,段雪英,王增武,等.社区复方制剂抗高血压治疗研究:2年干预效果分析[J].中国循环杂志,2015,30(5):449-454.DOI:10.3969/j. issn. 1000-3614.2015.05.010.Wang X, Duan XY, Wang ZW, et al. Investigation of antihypertensive therapy by compound medication in community healthcare:a 2-year intervention analysis[J]. Chinese Circulation Journal,2015,30(5);449-454. DOI:10. 3969/j. issn. 1000-3614. 2015.05.010.
[3]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122. DOI:10. 3760/cma. j. issn. 0253-3758.2014.02.004.Chinese Society of Cardiology, Editorial board of Chinese Journal of cardiology. Guidelines for diagnosis and treatment of heart failure in China 2014[J]. Chinese Journal of Cardiology, 2014,42(2):98-122. DOI:10. 3760/cma. j. issn. 0253-3758.2014.02.004.
[4]俞梅,许逸飞,吕淑敏,等.辨证使用参附、参麦注射液对扩张型心肌病心力衰竭患者6分钟步行试验、BNP、hsCRP的影响[J].中华全科医学,2014,12(6):993-996.Yu M, Xu YF, Lyu SM, et al. Effects of dialectical use of Shenfu,Shenmai injection on 6-minute walk, B-type natriuretic peptide and high-sensitive C-creative protein in patients with heart failure by dilated cardiomyopathy[J]. Chinese Journal of General Practice,2014,12(6):993-996.
[5]王生平,冯胜红,冯永生,等.芪苈强心胶囊佐治缺血性心肌病左心衰竭的临床价值[J].疑难病杂志,2015,14(12):1284-1287. DOI:10.3969/j.issn. 1671-6450.2015.12.023.Wang SP, Feng SH, Feng YS, et al. The clinical value of Qiliqiangxin capsule in assistant treatment of left heart failure in patients with ischemic cardio-myopathy[J]. Chinese Journal of Difficult and Complicated Cases, 2015,14(12):1284-1287. DOI:10.3969/j. issn. 1671-6450.2015.12.023.
[6]吴迪,姚克纯,李利,等.应用心肌声学造影评价冠状动脉血运重建术心肌灌注[J].中国超声医学杂志,2013,29(4):338-341. DOI:10.3969/j. issn. 1002-0101.2013.04.017.Wu D, Yao KC, Li L, et al. The value of myocardial contrast echocardiography(MCE)for myocardial blood flow analysis in follow-up ischemic heart disease after coronary artery revaracularation[J].Chinese Journal of Ultrasound in Medicine, 2013,29(4):338-341. DOI:10.3969/j.issn. 1002-0101.2013.04.017.
[7] Perkins RE, Hollingsworth KG, Eggett C, et al. Relationship between bioreactance and magnetic resonance imaging stroke volumes[J]. Br J Anaesth, 2016,117(1):134-136. DOI:10.1093/bja/aew164.
[8] Aoka Y, Hagiwara N, Kasanuki H, et al. Heterogeneity of hemodynamic pa-rameters in untreated primary hypertension, and individualiza-tion of antihypertensive therapy based on noninvasive hemody-namic measurements[J]. Clin Exp Hypertens, 2013,35(1):61-66. DOI:10.3109/10641963.2012.690469.
[9]姚恩辉,李世春,王华军.心脉隆注射液对慢性心力衰竭患者心功能及血浆B型钠尿肽的影响[J].中国全科医学,2014,17(27):3239-3241. DOI:10.3969/j. issn. 1007-9572.2014.27.020.Yao EH, Li SC, Wang HJ. Effects of Xinmailong injection on cardiac function and plasma BNP level in the patients with chronic heart failure[J]. Chinese General Practice, 2014,17(27):3239-3241. DOI:10.3969/j.issn. 1007-9572.2014.27.020.
[10]张忠晶,曹兵,倪伟.心脉隆干预治疗对慢性心功能不全患者心率减速力水平的影响[J].实用药物与临床,2018,21(2):157-160. DOI:10.14053/j.cnki.ppcr.201802008.Zhang ZJ, Cao B, Ni W. Influence of Xinmailong on deceleration capacity in patients with chronic heart failure[J]. Practical Pharmacy and Clinical Remedies, 2018,21(2):157-160. DOI:10.14053/j. cnki. ppcr. 201802008.
[11]李宏丽,王小艳,石卉,等.心力衰竭新标记物临床研究进展[J].心脏杂志,2014,26(4):484486,490.DOI:10.13191/j. chj. 2014.0063.Li HL, Wang XY, Shi H, et al. Clinical research progress in novel biomarkers of heart failure[J]. Chinese Heart Journal,2014,26(4):484-486,490. DOI:10.13191/j. chj.2014.0063.
[12]张慧颖,郝艳丽,李延辉,等.重组人脑利钠肽对老年急性失代偿心力衰竭患者的疗效及预后分析[J].疑难病杂志,2017,16(4):340-343. DOI:10.3969/j. issn. 1671-6450.2017.04.005.Zhang HY, Hao YL, Li YH, et al. Efficacy and prognosis of recombinant human brain natriuretic peptide in elderly patients with acute decompensated heart failure[J]. Chinese Journal of Difficult and Complicated Cases, 2017,16(4):340-343. DOI:10.3969/j. issn. 1671-6450.2017.04.005.