小剂量多巴胺联合重组人脑钠肽治疗急性前壁心肌梗死PCI术后合并心力衰竭患者的疗效

摘要

目的 观察小剂量多巴胺联合重组人脑钠肽(rhBNP)治疗急性前壁心肌梗死急诊经皮冠状动脉介入治疗(PCI)术后合并心力衰竭患者的效果及对预后的影响.方法 选择新疆医科大学附属中医医院心脏中心于2013年6月~2016年1月因急性前壁心肌梗死住院并于12 h内行急诊PCI术后发生心力衰竭的患者108例,其中男性70例,女性38例;年龄42~79岁,平均(58.0±12.7)岁.随机分为对照组(56例)和试验组(52例),两组均给予常规抗缺血、纠正心力衰竭及小剂量多巴胺治疗,试验组加用rhBNP,并维持72 h.于PCI术前及药物治疗72 h后测定两组N末端脑钠肽前体(NT-proBNP)浓度,应用心脏超声测定左室舒张末期容积(LVEDV)和左室收缩末期容积(LVESV)并计算左室射血分数(LVEF).根据临床症状判断患者术后72 h的治疗效果.出院后随访3个月,记录患者再住院及心血管死亡事件.结果 与治疗前相比,治疗72 h后试验组与对照组NT-proBNP水平均明显下降,其中试验组下降更明显,差异有统计学意义(P均<0.05).两组患者LVEF、LVESV及LVEDV治疗前后比较,差异无统计学意义(P均>0.05).试验组患者治疗后显效36例(64.3%),有效12例(21.4%);对照组患者显效17例(32.7%),有效10例(19.2%),试验组总有效率高于对照组(85.7% vs. 51.9%),差异有统计学意义(P<0.01).随访3个月,试验组患者再住院4例(7.1%),心血管死亡2例(3.6%).对照组再住院11例(21.2%),心血管死亡4例(7.7%).试验组再住院率明显低于对照组,差异有统计学意义(P<0.01).结论 小剂量多巴胺联合重组人脑钠肽治疗急性前壁心肌梗死急诊PCI术后合并心力衰竭患者症状及预后改善更明显.%Objective To observe the curative effect of low-dose dopamine combined with recombinant human brain natriuretic peptide (rhBNP) and the influence on prognosis in patients with anterior acute myocardial infarction (AMI) complicated by heart failure (HF) after percutaneous coronary intervention (PCI). Methods The patients hospitalized due to acute AMI and received emergency PCI within 12 h then attacked by HF (n=108, male 70, female 38, aged from 42 to 79 and average age=58.0±12.7) were chosen from the Center of Cardiology of Hospital of Traditional Chinese Medicine affiliated to Xinjiang Medical University from June 2013 to Jan. 2016. All patients were divided randomly into control group (n=56) and test group (n=52), and given routine treatment of anti-ischemia, correcting HF and low-dose dopamine for 72 h. The test group was additionally give rhBNP for 72 h. The level of N-terminal pro-brain natriuretic peptide (NT-proBNP) was detected before PCI and 72 h after medication. The indexes of left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were detected and calculated by using echocardiogram. The curative effect was reviewed according to clinical symptoms after 72 h. The patients were followed up for 3 months for recording re-hospitalization rate, cardiovascular events and mortality. Results The level of NT-proBNP decreased significantly in 2 groups after treatment for 72 h and the decrease was more significant in test group (all P<0.05). The comparison in LVEF, LVESV and LVEDV had no statistical significance in 2 groups before and after treatment (all P>0.05). There were 36 (64.3%) patients with significant curative effect and 12 (21.4%) with effectiveness in test group, and 17 (32.7%) with significant curative effect and 10 (19.2%) with effectiveness in control group. The total effective rate was higher in test group than that in control group (85.7% vs. 51.9%, P<0.01). After follow-up for 3 months, there were 4 (7.1%) cases of re-hospitalization, and 2 (3.6%) of cardiovascular death in test group.There were 11 (21.2%) cases of re-hospitalization, and 4 (7.7%) of cardiovascular death infarction in control group. The re-hospitalization rate was significantly lower in test group than that in control group (P<0.01). Conclusion The symptoms and prognosis are significantly relieved and improved by low-dose dopamine combined with rhBNP in patients with anterior AMI complicated by HF after PCI.