重组人脑钠肽对老年急性心肌梗死行急诊介入术后并发急性左心衰竭患者预后的影响

摘要

目的 探讨重组人脑钠肽(rhBNP)对老年急性心肌梗死行急诊介入术后并发急性左心衰竭患者预后的影响.方法 回顾性收集首都医科大学附属北京安贞医院2014年1月至2016年1月收治的207例急性心肌梗死介入治疗后合并急性左心衰竭的老年患者的临床资料.根据治疗措施将患者分为rhBNP组(68例)和对照组(139例).比较2组患者住院期间的心功能和呼吸困难改善情况,并随访观察1年内主要不良心血管事件(MACE)发生情况,应用多元Logistic回归分析MACE的危险因素.结果 治疗后rhBNP组心率低于,平均动脉压、左心室射血分数高于对照组[(88±15)次/min比(97±12)次/min、(87±5)mmHg(1 mmHg=0.133 kPa)比(79±6)mmHg、(35±10)％比(33±7)％],差异均有统计学意义(均P＜0.05).rhBNP组针对呼吸困难的总有效率高于对照组[86.7％ (59/68)比70.0％ (97/139)],差异有统计学意义(P＜0.01).随访1年rhBNP组和对照组MACE发生率差异无统计学意义(P＞0.05).Logistic回归分析发现氨基末端B型脑钠肽前体(NT-proBNP)(比值比=0.842,95％置信区间:0.532～0.948,P=0.002)和左心室射血分数(比值比=0.743,95％置信区间:0.631 ～0.803,P=0.004)为预测MACE的危险因素.结论 rhBNP能改善老年急性心肌梗死行急诊介入术后并发急性左心衰竭患者的左心功能和呼吸困难症状,部分降低短期的MACE发生率.NT-proBNP和左心室射血分数是影响预后的危险因素.%Objective To explore the effect of recombinant human brain natriuretic peptide(rhBNP) on prognosis of acute left heart failure after emergency coronary intervention in elderly patients with acute myocardial infarction.Methods A total of 207 elderly patients who had acute left heart failure after coronary intervention for myocardial infarction were enrolled from January 2014 to January 2016 in Beijing Anzhen Hospital,Capital Medical University.According to different therapeutic measures,the patients were divided into rhBNP group(n =68) and control group (n =139).Heart function and dyspnea recovery were observed.Occurrence of major adverse cardiovascular events(MACE) was followed up in 1 year after treatment.Risk factors of MACE were analyzed by multivariate logistic regression.Results After treatment,heart rate in rhBNP group was significantly lower,mean arterial pressure and left ventricular ejection fraction were significantly higher than those in control group [(88 ±15)times/minvs(97±12)times/min,(87±5)mmHg vs(79±6)mmHg,(35±10)％ vs(33±7)％](P＜0.05).Total effective rate of expiratory dyspnea in rhBNP group was significantly higher than that in control group [86.7％ (59/68) vs 70.0％ (97/139)] (P ＜ 0.01).One-year MACE rate showed no significant difference between groups (P ＞ 0.05).Logistic regression analysis demonstrated that N-terminal pro-B-type natriuretic peptide(NT-proBNP) (odds ratio =0.842,95％ confidence interval:0.532-0.948,P =0.002) and left ventricular ejection fraction(odds ratio =0.743,95％ confidence interval:0.631-0.803,P =0.004) were risk factors of MACE.Conclusions RhBNP can improve cardiac function,alleviate dyspnea and reduce MACE in elderly myocardial infarction patients with acute left heart failure after coronary intervention.NT-proBNP and left ventricular ejection fraction are risk factors of the prognosis.