张美玲河南辉县市中医院药剂科，河南辉县　453600

重组人脑利钠肽联合硝普钠治疗难治性心力衰竭的疗效探讨

张美玲
河南辉县市中医院药剂科，河南辉县453600

目的研究重组人脑利钠肽联合硝普钠治疗难治性心力衰竭的临床效果。方法对2015年3月—2015年6月收治的74例难治性心衰患者随机分为观察组和对照组，每组37例。两组患者除给予血管紧张素转化酶抑制剂、利尿等常规治疗方案外，对照组静脉泵入硝普钠治疗，疗程3～7 d；观察组给予重组人脑利钠肽联合硝普钠治疗，用药1～3 d，观察治疗前后两组患者的疗效及用药安全性。结果两组患者经治疗后SV、LVEF、CI、CO和体内NT-proBNP含量均得到改善，且观察组总有效率91.89%、SV（86.05±7.76）mL、LVEF（45.06±5.94）%、CI（4.48± 0.86）、CO（5.29±1.26）mL和NT-proBNP（2136.71±517.65）pg/mL，改善明显优于对照组62.16%、（73.85±8.08）mL、（39.01±3.83）%、（3.24±0.94）、（4.38±3.07）mL和（3327.45±509.43）pg/mL，（P＜0.05）；观察组发生一般不良反应率为5.41%，基本与对照组2.70%一致（P＞0.05），未发现严重不良反应。结论重组人脑利钠肽联合硝普钠治疗难治性心力衰竭，临床效果和心功能改善更明显，且安全性高，值得在临床应用中推广。

冻干脑利钠肽；注射用硝普钠；难治性心力衰竭

［Abstract］Objective To study the clinical effect of recombinant human brain natriuretic peptide and sodium nitroprusside in the treatment of refractory heart failure.Methods 74 cases of refractory heart failure were randomly divided into the observation group（n=37）and the control group（n=37）from March 2015 to June 2015，two groups of patients treated with angiotensin converting enzyme inhibitor，diuretic and other conventional treatment scheme，The control group was given intravenous infusion of sodium nitroprusside treatment，treatment 3～7 d.The observation group was given recombinant human brain natriuretic peptide combined with sodium nitroprusside treatment，medication 1～3d.Observe the efficacy and safety of drug use in the two groups before and after treatment.Results Two groups of patients after treatment SV，LVEF，CI，CO and NT-proBNP content in vivo were improved，the total effective rate91.89%、SV（86.05±7.76）mL、LVEF（45.06±5.94）%、CI（4.48±0.86）、CO（5.29±1.26）mL and NT-proBNP（2136.71±517.65）pg/mL of observation group were better the total effective rate62.16%、（73.85±8.08）mL、（39.01±3.83）%、（3.24±0.94）、（4.38±3.07）mL and （3327.45±509.43）pg/mL of control group，（P＜0.05）；The incidence of adverse reactions in the observation group was 5.41%，Consistent with the control group2.70%，（P＞0.05），No serious adverse reactions were found.Conclusion Recombinant human brain natriuretic peptide combined with sodium nitroprusside in treating refractory heart failure，clinical effect and heart function improvement is more obvious，and the safety of high，it is worth popularization in clinical application.

［Key words］Lyophilized injection with sodium nitroprusside；Brain natriuretic peptide；Refractory heart failure

表2　心功能指标和NT-proBNP含量比较（±s）

表2　心功能指标和NT-proBNP含量比较（±s）

组别观察组（n=37）对照组（n=37）SV（mL）治疗前　　治疗后LVEF（%）治疗前　　治疗后CI治疗前　　治疗后CO（mL）治疗前　　治疗后NT-proBNP（pg/mL）治疗前　　治疗后t P 58.77±13.65 64.33±13.86 1.072 0.415 （86.05±7.76）*（73.85±8.08）*2.193 0.041 32.52±6.81 34.91±3.83 0.773 0.465 （45.06±5.94）*（39.01±3.83）*2.116 0.047 2.64±1.05 2.79±1.12 1.174 0.336 （4.48±0.86）*（3.24±0.94）*2.414 0.021 3.77±2.53 3.62±1.95 1.279 0.193 （5.29±1.26）*（4.38±3.07）*2.499 0.018 4735.14±674.23 4662.18±527.34 1.326 0.187 （2136.71±517.65）*（3327.45±509.43）*2.431 0.020

难治性心力衰竭为慢性疾病，是心脏病发展的终末结果，多与心功能不全、神经内分泌失调、外周血流异常分布等诱发因素有关，使心排量降低，心室扩大，心功能衰竭，极易引起心血管事件［1］。临床常用卧床休息、限水钠摄入、利尿、强心和给予扩血管剂等治疗效果欠佳。……