左西孟旦与冻干重组人脑利钠肽联合治疗老年心力衰竭对患者心脏功能和血流动力学水平影响
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摘要
目的探讨左西孟坦联合冻干重组人脑利钠肽治疗老年心力衰竭患者的临床效果。方法选取2015年1月至2018年1月我院诊治的80例老年心力衰竭患者作为研究对象,依据Excel 2007编写的随机数字表分为观察组和对照组各40例,两组患者均给予强心、利尿等基础治疗措施,观察组同时给予左西孟坦联合冻干重组人脑利钠肽治疗,对照组同时给予左西孟坦联合多巴酚丁胺治疗;对比两组患者治疗前后的左室舒张末期内经(LVEDD)、左室射血分数(LVEF)、心脏指数(CI)、每搏输出量(SV)、血清胱抑素C(Cys-C)、氨基末端脑钠肽前体(NT-proBNP)、平均动脉压(MAP)、肺毛细血管契压(PCWP)。结果治疗前,观察组和对照组患者的LVEDD、LVEF、CI、SV水平差异不具有统计学意义(P> 0.05);治疗后,观察组患者的LVEDD显著的低于对照组(P <0.05),观察组的LVEF、CI、SV测定值显著高于对照组(P <0.05);治疗前,观察组和对照组患者的血清Cys-C、NT-proBNP水平差异不具有统计学意义(P>0.05);治疗后,观察组患者的血清Cys-C、NT-proBNP水平显著的低于对照组(P <0.05);治疗前,观察组和对照组患者的MAP、PCWP水平差异不具有统计学意义(P> 0.05);治疗后,观察组患者的MAP、PCWP水平显著的低于对照组(P <0.05);观察组患者的不良反应发生率10.00%与对照组的5.00%差异不具有统计学意义(P> 0.05)。结论左西孟坦联合冻干重组人脑利钠肽治疗老年心力衰竭患者能显著的改善患者心功能、降低Cys-C、NT-proBNP水平,改善血流动力学指标。
Objective To investigate the clinical effects of levosimmentan combined with freeze-dried recombinant human brain natriuretic peptide in elderly patients with heart failure. Methods Eighty patients with heart failure diagnosed in our hospital from January 2015 to January 2018 were selected as subjects. According to the random number table prepared in Excel 2007, 40 patients in the experimental group and the control group were given. For basic treatments such as diuresis, the experimental group was treated with levosimtan combined with lyophilized recombinant human brain natriuretic peptide, and the control group was treated with levosimtan and dobutamine. The left ventricle of the two groups before and after treatment was compared. End-diastolic period(LVEDD), left ventricular ejection fraction(LVEF), cardiac index( CI), stroke volume(SV), serum cystatin C(Cys-C), amino terminal brain natriuretic peptide precursor(NT-proBNP), mean arterial pressure( MAP),pulmonary capillary pressure(PCWP). Results Before treatment, the differences of LVEDD, LVEF, CI and SV levels between the experimental group and the control group were not statistically significant(P > 0.05). After treatment, the LVEDD of the experimental group was significantly lower than that of the control group(P < 0.05).The LVEF, CI and SV values in the experimental group were significantly higher than those in the control group(P < 0.05). There was no significant difference in serum Cys-C and NT-proBNP levels between the experimental group and the control group before treatment(P > 0.05). After treatment, the serum levels of Cys-C and NT-proBNP in the experimental group were significantly lower than those in the control group(P < 0.05). Before treatment, the difference of MAP and PCWP levels between the experimental group and the control group was not statistically significant(P > 0.05). After treatment, the MAP and PCWP levels in the experimental group were significantly lower than those in the control group(P < 0.05). The incidence of adverse reactions in the experimental group was 10.00% and the difference between the control group and the control group was not statistically significant(P>0.05). Conclusions Levosimmentan combined with freeze-dried recombinant human brain natriuretic peptide in patients with senile heart failure can significantly improve cardiac function, reduce Cys-C, NT-proBNP levels, and improve hemodynamic parameters.
Objective To investigate the clinical effects of levosimmentan combined with freeze-dried recombinant human brain natriuretic peptide in elderly patients with heart failure. Methods Eighty patients with heart failure diagnosed in our hospital from January 2015 to January 2018 were selected as subjects. According to the random number table prepared in Excel 2007, 40 patients in the experimental group and the control group were given. For basic treatments such as diuresis, the experimental group was treated with levosimtan combined with lyophilized recombinant human brain natriuretic peptide, and the control group was treated with levosimtan and dobutamine. The left ventricle of the two groups before and after treatment was compared. End-diastolic period(LVEDD), left ventricular ejection fraction(LVEF), cardiac index( CI), stroke volume(SV), serum cystatin C(Cys-C), amino terminal brain natriuretic peptide precursor(NT-proBNP), mean arterial pressure( MAP),pulmonary capillary pressure(PCWP). Results Before treatment, the differences of LVEDD, LVEF, CI and SV levels between the experimental group and the control group were not statistically significant(P > 0.05). After treatment, the LVEDD of the experimental group was significantly lower than that of the control group(P < 0.05).The LVEF, CI and SV values in the experimental group were significantly higher than those in the control group(P < 0.05). There was no significant difference in serum Cys-C and NT-proBNP levels between the experimental group and the control group before treatment(P > 0.05). After treatment, the serum levels of Cys-C and NT-proBNP in the experimental group were significantly lower than those in the control group(P < 0.05). Before treatment, the difference of MAP and PCWP levels between the experimental group and the control group was not statistically significant(P > 0.05). After treatment, the MAP and PCWP levels in the experimental group were significantly lower than those in the control group(P < 0.05). The incidence of adverse reactions in the experimental group was 10.00% and the difference between the control group and the control group was not statistically significant(P>0.05). Conclusions Levosimmentan combined with freeze-dried recombinant human brain natriuretic peptide in patients with senile heart failure can significantly improve cardiac function, reduce Cys-C, NT-proBNP levels, and improve hemodynamic parameters.
引文
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[10]胡伟,王丽丽.左西孟旦治疗急性失代偿性心力衰竭患者的临床疗效及不良反应观察[J].齐齐哈尔医学院学报,2015,25(14):2070-2071.
[11]WANG Y,GU X,FAN W,et al.Effects of recombinant human brain natriuretic peptide on renal function in patients with acute heart failure following myocardial infarction[J].Am J Transl Res,2016,8(1):239-245.
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[13]马小宁,康志敏,胡晓宁,等.冻干重组人脑利钠肽治疗心力衰竭的效果观察[J].河北医科大学学报,2017,38(7):829-831.
[2]解金红,关怀敏.冻干重组人脑利钠肽的用药时机对急性左心衰竭患者临床效果和预后的研究[J].中国医师进修杂志,2015,38(7):513-516.
[3]杨贤义,刘梅,柴林,等.冻干重组人脑利钠肽联合左西孟旦对急性心力衰竭的疗效及对UA和BNP的影响[J].中国临床研究,2017,30(6):767-769.
[4]郑喜胜,王松,倪猛,等.左西孟坦注射液联合无创呼吸机治疗老年急性心力衰竭的临床研究[J].中国临床药理学杂志,2017,33(12):1085-1087.
[5]ATHERTON J J,SINDONE A,DE PASQUALE C G,et al.National heart foundation of australia and cardiac society of australia and new zealand:Guidelines for the prevention,detection,and management of heart failure in Australia 2018[J].Heart Lung Circ,2018,27(10):1123-1208.
[6]SHAH S J,LAM C S P,SVEDLUND S,et al.Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction:PROMIS-HFpEF[J].Eur Heart J,2018,45(6):34-36.
[7]QI Z,LIU S,DUAN F.Effects of bone marrow mononuclear cells delivered through a graft vessel in patients with previous myocardial infarction and chronic heart failure:An echocardiographic study of left ventricular dyssynchrony[J].J Clin Ultrasound,2018,28(6):103-105.
[8]KERLEY C P.Dietary patterns and components to prevent and treat heart failure:a comprehensive review of human studies[J].Nutrition,2018,35(6):21-27.
[9]刘瑞龙.左西孟坦治疗老年重度心力衰竭的疗效及安全性分析[J].中国卫生标准管理,2017,8(2):83-84.
[10]胡伟,王丽丽.左西孟旦治疗急性失代偿性心力衰竭患者的临床疗效及不良反应观察[J].齐齐哈尔医学院学报,2015,25(14):2070-2071.
[11]WANG Y,GU X,FAN W,et al.Effects of recombinant human brain natriuretic peptide on renal function in patients with acute heart failure following myocardial infarction[J].Am J Transl Res,2016,8(1):239-245.
[12]WANG G,WANG P,LI Y,et al.Efficacy and safety of 1-hour infusion of recombinant human atrial natriuretic peptide in patients with acute decompensated heart failure[J].Medicine,2016,95(9):947-949.
[13]马小宁,康志敏,胡晓宁,等.冻干重组人脑利钠肽治疗心力衰竭的效果观察[J].河北医科大学学报,2017,38(7):829-831.