氨基末端B型利钠肽前体对心力衰竭药物优化治疗的效果观察

摘要

OBJECTIVE:To evaluate the efficacy of NT-proBNP-guided optimized therapy for heart failure. METHODS:60 patients with heart failure were randomized to either conventional treatment group ( control group ) or NT proBNP-guided treatment group ( observation group ) , with 30 cases each.The control group was treated with digitalis, diuretics, angiotensin converting enzyme inhibitors( ACEI) , angiotensin receptor antagonist( ARB) and beta receptor blockers, with drug type and doses adjusted based on the improvement in clinical symptoms and signs;while in the observation group, the types and doses of the above drugs were optimized based on the level of NT-proBNP.At 6-9 months of treatment, the efficacy in the two groups were evaluated with regarded to the average ventricular rate, left ventricular ejection fraction, six-minute walking distance, incidence of cardiac decompensation, renal function and cardiovascular mortality.RESULTS:There were no significant differences in average ventricular rate, left ventricular ejection fraction,renal function and cardiovascular mortality between the two groups( P>0.05) , while the observation group was significantly better than the control group in six-minute walking distance and incidence of cardiac decompensation( P<0.05 ) .CONCLUSIONS:NT-proBNP-guided optimized therapy for heart failure can increase the patient's six-minute walking distance and reduce the incidence of cardiac decompensation.%目的：探讨氨基末端B型利钠肽前体（ NT－proBNP）对心力衰竭药物优化治疗的效果。方法：选择60例心力衰竭患者，以随机数字表法分为常规治疗组（对照组）及在常规治疗基础上结合NT－proBNP水平变化优化药物治疗组（观察组），每组各30例。对照组患者以临床症状和体征改善为标准，调整利尿剂、洋地黄、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体阻断剂和β受体阻断剂的种类和剂量；观察组患者通过监测NT－proBNP水平的变化来进一步优化药物治疗剂量和种类。治疗6～9个月后，观察2组患者静息平均心室率、左心室射血分数、6 min步行距离、心功能失代偿发生率、肾功能、心血管死亡率等指标水平，比较2种方法的疗效。结果：2组患者静息平均心室率、左心室射血分数、肾功能、心血管死亡率等指标水平的差异无统计学差异（P＞0．05），观察组患者6 min步行距离、心功能失代偿发生率明显优于对照组，差异有统计学差异（P＜0．05）。结论：NT－proBNP指导心力衰竭药物优化治疗，能增加患者6 min步行距离、能减少心功能失代偿发生率。