| 赵坤芳,岳志城,费睿成.冻干重组人脑利钠肽联合缬沙坦氢氯噻嗪在急诊急性心力衰竭伴高血压病人中的应用[J].安徽医药,2021,25(2):412-416. |
| 冻干重组人脑利钠肽联合缬沙坦氢氯噻嗪在急诊急性心力衰竭伴高血压病人中的应用 |
| Application of lyophilized recombinant human brain natriuretic peptide combined with valsartan hydrochlorothiazide in emergency patients with acute heart failure accompanied hypertension |
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| DOI：10.3969/j.issn.1009-6469.2021.02.049. |
| 中文关键词: 心力衰竭 高血压 重组蛋白质类 冻干重组人脑利钠肽 缬沙坦氢氯噻嗪 |
| 英文关键词: Heart failure Hypertension Recombinant proteins Lyophilized recombinant human brain natriuretic peptide Valsartan hydrochlorothiazide |
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| 中文摘要: |
| 目的探讨冻干重组人脑利钠肽联合缬沙坦氢氯噻嗪在急诊急性心力衰竭( AHF)伴高血压病人中的应用。方法选取 2017年 4月至 2018年 12月郑州大学附属洛阳中心医院收治的 AHF伴高血压病人 106例，以随机数字表法分为对照组和联合组各 53例，对照组给予缬沙坦氢氯噻嗪 +螺内酯治疗，联合组给予冻干重组人脑利钠肽 +缬沙坦氢氯噻嗪 +螺内酯治疗。对比两组治疗前及治疗 2周后的血压、心率、心功能指标、心率变异性指标、血清肌钙蛋白T( TNT)、N末端 B型脑钠肽前体( NTproBNP)及胱抑素 C(Cys-C)水平变化，对比临床疗效及治疗期间的不良反应。结果治疗 2周后，收缩压( SBP)［对照组(165.16±34.83)mmHg比( 133.78±23.41)mmHg、联合组( 166.23±35.37)mmHg比( 124.32±22.57)mmHg］和舒张压( DBP)［对照组(108.76±22.75)mmHg比( 87.57±12.89)mmHg、联合组( 109.23±23.14)mmHg比( 82.16±13.17)mmHg］均降低( P < 0.05)，联合组更低( P < 0.05)；治疗 2周后，心脏指数( CI)［对照组( 2.13±0.37)L·min-1·m-2比( 3.32±0.53)L·min-1·m-2、联合组( 2.15±0.24)L· min-1·m-2比( 3.65±0.48)L·min-1·m-2］、心排血量( CO)［对照组( 4.96±0.32)L/min比( 5.23±0.85)L/min、联合组( 4.95±0.36)L/min比(5.41±0.72)L/min］及左室射血分数( LVEF)［对照组( 50.79±7.26)%比( 55.37±7.18)%、联合组( 51.03±6.83)%比( 59.37±7.52)%］均显著高于治疗前( P < 0.05)且联合组 CI、LVEF均更高( P < 0.05)两组病人心率( HR)［对照组( 88.28±9.14)次 /分比( 77.83±6.51)次 /分、次/分比( 73.58±7.16)次 /分］明显低疗前( P < 0.05)，联合组更低( P < 0.05)；治疗 2周后，两组 RR间期标准差( SDNN)、相邻 RR间期差值均方根( RMSSD)及相邻 RR之差 >50 ms个数所占百分比( PNN50)均明显高于治疗前( P < 0.05)联合组均更高(P < 0.05)； TNT、NT-proBNP及 Cys-C水平均明显低于治疗前( P < 0.05)联合组更低(P < 0.05)；联合组(87.94±8.86)，于治，两组临床疗效分布，差异有统计学意义( P < 0.05)联合组总有效率明显高于对照组( 94.45%比 77.36%，P，< 0.05)；治疗期间两组病人不良反应发生率相近( P>0.05)。结论冻干，重组人脑利钠肽联合缬沙坦氢氯噻嗪治疗可显著降低急诊 AHF伴高血压病人血压、改善心功能及心率变异性，减慢心率，显著降低 TNT、NT-proBNP及 Cys-C水平，增强疗效且安全可靠。 |
| 英文摘要: |
| Objective To explore the application of lyophilized recombinant human brain natriuretic peptide combined with valsartan hydrochlorothiazide in emergency patients with acute heart failure (AHF) accompanied hypertension.Methods One hundred and six patients with AHF and hypertension in emergency who were admitted to Luoyang Central Hospital of Zhengzhou University fromApril 2017 to December 2018 were selected and randomized into control group and combined group, 53 cases in each group.The control group was treated with valsartan hydrochlorothiazide + spironolactone, while the combined group was treated with novobin + valsartan hydrochlorothiazide + spironolactone. The changes of blood pressure, heart function, heart rates, heart rate variability, serum troponin T (TNT),N-terminal B-type natriuretic peptide precursor (NT-proBNP) and cystatin C (Cys-C) levels were compared between the twogroups before and after 2 weeks of treatment.The clinical efficacy and adverse reactions during treatment were compared.Results After 2 weeks of treatment, systolic blood pressure (SBP) [the control group (165.16±34.83) mmHg vs. (133.78±23.41) mmHg, the combined group (166.23±35.37) mmHg vs. (124.32±22.57) mmHg] and diastolic blood pressure (DBP) [the control group (108.76±22.75) mmHg vs. (87.57±12.89) mmHg, the combined group (109.23±23.14) mmHg vs. (82.16±13.17) mmHg] decreased in both groups (P < m-20.05), which in the combined group were lower (P < 0.05).Cardiac index (CI) [the control group (2.13±0.37) L·min-1·vs. (3.32±0.53) m-2L·min-1·m-2, the combined group (2.15±0.24) L·min-1·vs. (3.65±0.48) L·min-1·m-2], cardiac output (CO) [the control group (4.96± 0.32) L/min vs. (5.23±0.85) L/min, the combined group (4.95±0.36) L/min vs. (5.41±0.72) L/min] and left ventricular ejection fraction (LVEF) values [the control group (50.79±7.26)% vs. (55.37±7.18)%, the combined group (51.03±6.83)% vs. (59.37±7.52)%] were significantly higher than those before treatment (P < 0.05), CI and LVEF were higher in the combined group (P < 0.05). Heart rates (HR) in the two groups were significantly lower than those before treatment [the control group (88.28±9.14) vs. (77.83±6.51),the combined group (87.94±8.86) vs. (73.58±7.16), P < 0.05],which in the combined group was lower (P < 0.05).After 2 weeks of treatment, the percentageof the difference of the standard deviation of RR interval (SDNN),the difference of the mean square root of the adjacent RR interval(RMSSD) and the number of adjacent RRs>50 ms (pNN50) in the two groups were significantly higher than those before treatment (P < 0.05),and higher than those in the combined group (P < 0.05). The levels of TNT, NT-proBNP and Cys-C were significantly lower than those before treatment (P < 0.05), while those in the combined group were lower (P < 0.05).There was a significant difference in the distribution of clinical efficacy between the two groups (P < 0.05), and the total effective rate of the combined group was significantly higher than that of the control group (94.45% vs. 77.36%,P < 0.05). The incidence of adverse reactions was similar between the two groups during treatment (P>0.05).Conclusion The combination of novobin and valsartan hydrochlorothiazide can significantly reduce theblood pressure of AHF patients with hypertension, improve heart function and heart rate variability,slow heart rate, significantly reducethe levels of TNT,NT proBNP and Cys-C,enhance the efficacy and safety. |
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