重组人脑利钠肽对急性失代偿性心力衰竭的疗效及相关指标的影响探讨.pdf

102中国现代药物应用2024年3月第18卷第6期Chin J Mod Drug Appl,Mar 2024,Vol.18,No.6重组人脑利钠肽对急性失代偿性心力衰竭的疗效及 相关指标的影响探讨 岳晓燕张艳芳【摘要】目的观察重组人脑利钠肽(rhBNP)对急性失代偿性心力衰竭的疗效及相关指标的影响。方法78 例急性失代偿性心力衰竭患者,根据治疗方案差异分成对照组与观察组,每组 39 例。对照组采取常规治疗,观察组在对照组基础上加用重组人脑利钠肽治疗。比较两组治疗前后临床症状评分、炎性介质水平、血管内皮功能、心功能指标及生存质量。结果治疗后,两组呼吸困难、下肢水肿、入睡困难、喘息不止、颈静脉怒张评分较治疗前更低,且观察组呼吸困难、下肢水肿、入睡困难、喘息不止、颈静脉怒张评分分别为(1.050.26)、(1.430.25)、(0.770.21)、(1.510.45)、(1.290.62)分,较对照组的(2.520.89)、(2.310.67)、(1.070.38)、(2.120.36)、(2.310.72)分更低(P0.05)。治疗后,两组肿瘤坏死因子-、白细胞介素-6、超敏 C 反应蛋白水平较治疗前更低,且观察组肿瘤坏死因子-、白细胞介素-6、超敏 C 反应蛋白水平分别为(0.430.15)pg/L、(8.861.51)pg/ml、(8.10 1.15)mg/L,较对照组的(0.610.11)pg/L、(10.511.62)pg/ml、(10.321.22)mg/L 更低(P0.05)。治疗后,两组一氧化氮、内皮素-1 水平较治疗前更低,且观察组一氧化氮水平(53.817.92)mol/L、内皮素-1水平(40.912.30)ng/L 较对照组的(60.466.42)mol/L、(52.163.63)ng/L 更低(P0.05)。两组治疗后左心室射血分数、心输出量、心脏指数较治疗前更高,左心室舒张末期内径、左心室收缩末期内径较治疗前更小,且观察组左心室射血分数、心输出量、心脏指数较对照组更高,左心室舒张末期内径、左心室收缩末期内径较对照组更小(P0.05)。两组治疗后生理、心理、社会关系、环境评分较治疗前更高,且观察组较对照组更高(P0.05)。结论采用重组人脑利钠肽治疗急性失代偿性心力衰竭效果显著,其能够改善患者临床相关症状及血管内皮功能,有助于心功能早日恢复至健康状态。【关键词】重组人脑利钠肽；急性失代偿性心力衰竭；疗效；血管内皮功能；心功能DOI：10.14164/11-5581/r.2024.06.026Efficacy of recombinant human brain natriuretic peptide on acute decompensated heart failure and its influence on related indicators YUE Xiao-yan,ZHANG Yan-fang.Weihai Second Hospital Affiliated to Qingdao University,Weihai 264200,China【Abstract】Objective To observe the efficacy of recombinant human brain natriuretic peptide(rhBNP)on acute decompensated heart failure and its influence on related indicators.Methods 78 patients with acute decompensated heart failure were divided into a control group and an observation group based on different treatment plans,with 39 cases in each group.The control group received conventional treatment,and the observation group was treated with recombinant human brain natriuretic peptide on the basis of the control group.The clinical symptom score,inflammatory mediator level,vascular endothelial function,cardiac function and quality of life were compared between the two groups before and after treatment.Results After treatment,the scores of dyspnea,lower limb edema,difficulty in sleeping,wheezing and jugular vein distention were lower than those before treatment;the scores of dyspnea,lower limb edema,difficulty in sleeping,wheezing and jugular vein distention in the observation group were(1.050.26),(1.430.25),(0.770.21),(1.510.45)and (1.290.62)points,which were lower than(2.520.89),(2.310.67),(1.070.38),(2.120.36)and(2.310.72)points in the control group(P0.05).After treatment,the levels of tumor necrosis factor-,interleukin-6 and hypersensitive C-reactive protein in both groups were lower than those before treatment;the levels of tumor necrosis factor-,interleukin-6 and hypersensitive C-reactive protein in the observation group were(0.430.15)pg/L,(8.861.51)pg/ml and(8.101.15)mg/L,which were lower than(0.610.11)pg/L,(10.511.62)pg/ml and(10.321.22)mg/L in the control group(P0.05).After treatment,both groups had higher nitric oxide levels and endothelin-1 levels than those before treatment;the observation group had nitric oxide level of(53.817.92)mol/L and endothelin-1 level of(40.912.30)ng/L,which were lower than(60.466.42)mol/L and(52.163.63)ng/L in the control group(P0.05),具有可比性。纳入标准：存在呼吸困难、喘息不止、入睡困难等表现；胸片提示肺淤血,伴或不伴胸腔积液；心肌酶显示异常,脑利钠肽 400 ng/L；超声心电图提示左室射血分数45%。排除标准：合并器质性疾病；合并肝肾功能异常者；存在认知、表达能力异常者。1.2方法1.2.1对照组患者采取常规治疗。给予患者吸氧,呋塞米2040 mg静脉推注(静推),托拉塞米1020 mg静推；采用微量泵输注硝酸甘油静脉给药,从 510 g/min 开始,以后每 510 分钟递增 510 g/min,最大剂量200 g/min,直至心力衰竭的症状缓解。ejection fraction,cardiac output,and cardiac index in both groups were higher than those before treatment,and the left ventricular end-diastolic diameter and left ventricular end-systolic diameter were smaller than those before treatment;the left ventricular ejection fraction,cardiac output,cardiac index in the observation group were higher than those before treatment,and the left ventricular end-diastolic diameter,left ventricular end-systolic diameter were smaller than those in the control group(P0.05).After treatment,the physical,psychological,social relationship,and environmental scores in both groups were higher than those before treatment,and the observation group was higher than the control group(P0.05).Conclusion Recombinant human brain natriuretic peptide is effective in the treatment of acute decompensated heart failure,which can improve the clinical symptoms and vascular endothelial function of patients,and help to restore the heart function to a healthy state early.【Key words】Recombinant human brain natriuretic peptide;Acute decompensated heart failure;Efficacy;Vascular endothelial function;Cardiac function1.2.2观察组患者在对照组基础上加用重组人脑利钠肽治疗。重组人脑利钠肽以 1.5 g/kg 静脉冲击后,以 0.0075 g/(kgmin)的速度连续静脉滴注。连续 24 h 静脉滴注。两组均连续治疗 3 d。随访 1 个月。1.3观察指标及判定标准1.3.1比较两组治疗前后临床症状评分采取自拟量表评定,包含呼吸困难、下肢水肿、入睡困难、喘息不止、颈静脉怒张等,以临床症状轻重分为 06 分,症状越严重则得分越高5。1.3.2比较两组治疗前后炎性介质水平炎性介质包含肿瘤坏死因子-、白细胞介素-6、超敏 C 反应蛋白6。1.3.3比较两组治疗前后血管内皮功能指标水平血管内皮功能指标包含一氧化氮、内皮素-17。1.3.4比较两组治疗前后心功能指标心功能指标包含左心室舒张末期内径、左心室收缩末期内径、左心室射血分数、心输出量、心脏指数8。1.3.5比较两组治疗前后生存质量采取世界卫生组织生活质量测定量表(WHOQOL-BREF)评定生存质量,包含生理、心理、社会关系和环境等维度,从差到优分为 0100 分,生存质量越优则得分越高。1.4统计学方法采用 SPSS22.0 统计学软件对研究数据进行统计分析。计量资料以均数 标准差(x-s)表示,采用 t 检验；计数资料以率(%)表示,采用2检验。P0.05)；治疗后,两组呼吸困难、下肢水肿、入睡困难、喘息不止、颈静脉怒张评分较治疗前更低,且观察组较对照组更低(P0.05)；治疗后,两组肿瘤坏死因子-、白细胞介素-6、超敏 C 反应蛋白水104中国现代药物应用2024年3月第18卷第6期Chin J Mod Drug Appl,Mar 2024,Vol.18,No.6表 1两组治疗前后临床症状评分比较(x-s,分)组别例数呼吸困难下肢水肿入睡困难治疗前治疗后治疗前治疗后治疗前治疗后对照组394.681.012.520.89a4.361.202.310.67a3.261.311.070.38a观察组394.251.51 1.050.26ab4.161.02 1.430.25ab3.151.78 0.770.21abt1.4789.9010.7937.6850.3114.315P0.1430.0000.4300.0000.7570.000平较治疗前更低,且观察组较对照组更低(P0.05)；治疗后,两组一氧化氮、内皮素-1 较治疗前更低,且观察组一氧化氮、内皮素-1 水平较对照组更低(P0.05)；两组治疗后左心室射血分数、心输出量、心脏指数较治疗前更高,左心室舒张末期内径、左心室收缩末期内径较治疗前更小,且观察组左心室射血分数、心输出量、心脏指数较对照组更高,左心室舒张末期内径、左心室收缩末期内径较对照组更小(P0.05)；两组治疗后生理、心理、社会关系、环境评分较治疗前更高,且观察组较对照组更高(P0.05)。见表 5。组别例数喘息不止颈静脉怒张治疗前治疗后治疗前治疗后对照组393.691.172.120.36a3.961.012.310.72a观察组393.531.06 1.510.45ab3.831.21 1.290.62abt0.6336.6100.5156.704P0.5290.0000.6080.000注：与本组治疗前比较,aP0.05；与对照组治疗后比较,bP0.05表 2两组治疗前后炎性介质水平比较(x-s)组别例数肿瘤坏死因子-(pg/L)白细胞介素-6(pg/ml)超敏 C 反应蛋白(mg/L)治疗前治疗后治疗前治疗后治疗前治疗后对照组390.890.270.610.11a19.622.0810.511.62a11.672.4010.321.22a观察组390.970.23 0.430.15ab19.213.77 8.861.51ab11.072.12 8.101.15abt1.4096.0430.5954.6531.1708.269P0.1630.0000.5540.0000.2460.000注：与本组治疗前比较,aP0.05；与对照组治疗后比较,bP0.05表 3两组治疗前后血管内皮功能指标水平比较(x-s)组别例数一氧化氮(mol/L)内皮素-1(ng/L)治疗前治疗后治疗前治疗后对照组3975.816.5360.466.42a57.855.6352.163.63a观察组3976.986.41 53.817.92ab57.396.21 40.912.30abt0.7994.0730.34316.349P0.4270.0000.7330.000注：与本组治疗前比较,aP0.05；与对照组治疗后比较,bP0.05表 4两组治疗前后心功能指标比较(x-s)组别例数左心室舒张末期内径(mm)左心室收缩末期内径(mm)左心室射血分数(%)治疗前治疗后治疗前治疗后治疗前治疗后对照组3959.066.3746.383.42a51.293.0038.432.61a35.572.4343.893.36a观察组3960.315.26 42.872.89ab52.172.12 31.782.56ab35.652.31 50.723.21abt0.9454.8961.49611.3590.1499.179P0.3480.0000.1390.0000.8820.000105中国现代药物应用2024年3月第18卷第6期Chin J Mod Drug Appl,Mar 2024,Vol.18,No.6续表 4组别例数心输出量(L/min)心脏指数L/(minm2)治疗前治疗后治疗前治疗后对照组392.750.333.780.57a1.900.332.860.19a观察组392.650.31 4.350.41ab1.960.23 3.750.26abt1.3795.0700.93217.260P0.1710.0000.3550.000注：与本组治疗前比较,aP0.05；与对照组治疗后比较,bP0.05表 5两组治疗前后 WHOQOL-BREF 评分比较(x-s,分)组别例数生理心理社会关系环境治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后对照组3958.982.0873.213.57a50.653.2072.733.26a51.832.0670.283.09a52.761.4272.202.47a观察组3958.353.96 80.396.51ab50.763.11 81.374.38ab51.653.05 86.413.12ab52.881.69 85.372.61abt0.8806.0390.1549.8820.30522.9400.33922.888P0.3820.0000.8780.0000.7610.0000.7350.000注：与本组治疗前比较,aP0.05；与对照组治疗后比较,bP0.053讨论急性失代偿性心力衰竭是心力衰竭的一种严重表现,其病因较为复杂,多由急性心脏瓣膜功能障碍、急性重症心肌炎、围生期心肌病、严重心律失常等疾病所导致9。主要症状有气短、呼吸困难、咳嗽、水肿、入睡困难,甚至不能平卧。临床主要通过快速利尿、扩张血管等方法治疗以控制病情,但对患者神经系统方面无法起到保护作用,因此探究更为有效的方对案急性失代偿性心力衰竭患者有着重要意义10。脑利钠肽是由 32 个氨基酸残基组成的多肽,主要分布在人体的大脑、脊髓和心肺等组织当中,其中要以心脏含有脑利钠肽最高。脑利钠肽对心力衰竭患者而言,具有重要的病理与生理意义,能够促进排钠、促进排尿的作用,具有较强的舒张血管作用,对抗肾素-血管紧张素-醛固酮系统(RAAS)的扩血管作用。重组人脑利钠肽与内源脑利钠肽具有相同的氨基酸序列、空间结构,具有扩张血管、促进肾脏排出多余水分、盐分以及抑制神经过度兴奋作用,从而缓解心力衰竭患者的呼吸困难程度和全身症状11,12。本次研究中,治疗后,观察组呼吸困难、下肢水肿、入睡困难、喘息不止、颈静脉怒张评分及肿瘤坏死因子-、白细胞介素-6、超敏 C 反应蛋白水平较对照组更低(P0.05)。治疗后,观察组一氧化氮、内皮素-1水平较对照组更低(P0.05)。治疗后,观察组左心室射血分数、心输出量、心脏指数较对照组更高,左心室舒张末期内径、左心室收缩末期内径较对照组更小(P0.05)。治疗后,观察组生理、心理、社会关系、环境评分较对照组更高(P0.05)。探究发现重组人脑利钠肽具有抗炎、抗氧化及保护神经等多种作用；同时其能够保护人脑免受氧化应激、神经炎症等因素的损伤,减少神经细胞死亡,提高患者预后。综上所述,采用重组人脑利钠肽治疗急性失代偿性心力衰竭效果显著,其能够改善患者临床相关症状及血管内皮功能,有助于心功能早日恢复至健康状态。参考文献1 李智婷.重组人脑利钠肽对老年急性失代偿心力衰竭的疗效研究.中外女性健康研究,2022(23):35-36.2 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