冻干重组人脑利钠肽联合多巴酚丁胺治疗老年急性心肌梗死合并心力衰竭患者的临床研究OA

Objective To investigate the efficacy of dobutamine combined with lyophilized recombinant human brain natriuretic peptide(rhBNP)on elderly patients with acute myocardial infarction(AMI)and heart failure(HF).Methods Patients with AMI complicated with HF in our hospital were randomly divided into control group and treatment group.The control group was treated with dobutamine at a rate of2.5-10.0 μg·(kg·min)-1for 24 hours,and the treatment group was treated with rhBNP on the basis of the control group,with an initial dose of 1.0 μg·kg-1.The latter treatment was 0.0075 μg·(kg·min)-1 intravenous drip pump for 72 hours,and the two groups were treated for 7 days.Clinical efficacy,6-minute walking distance,cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)],myocardial injury markers[cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),N-terminal pro-B-type natriuretic peptide(NT-proBNP)],hemodynamic and volume status monitoring indexes[heart rate,systolic blood pressure,urine output],inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP)],safety and short-term prognosis indexes were compared between the two groups.Results A total of 120 eligible AMI complicated with HF patients were enrolled,with 60 cases in each of the treatment group and the control group.After treatment,the total effective rates of the treatment group and the control group were 93.33％(56/60 cases)and 80.00％(48/60 cases),respectively.The 6-minute walking distance of the treatment group and the control group were(380.70±40.08)and(315.60±35.10)m,respectively.LVEF:(52.85±5.32)vs.(47.21±4.80)％;LVEDD:(45.60±5.12)vs.(50.65±5.80)mm;LVESD:(32.64±4.45)vs.(40.58±6.27)mm;NT-proBNP was(721.68±75.20)and(1200.62±125.60)ng·L-1,cTnI was(12.60±2.40)and(25.30±3.18)μg·L-1,respectively.There were statistically significant differences between the two groups(P＜0.05).There was an interaction between the two groups of indicators at time points(all P＜0.05).The adverse reaction rates of the treatment group and the control group were 6.67％(4 cases/60 cases)and 11.67％(7 cases/60 cases),respectively,with no statistically significant difference(P＞0.05).The rehospitalization rates of the treatment group and the control group were 8.33％(5 cases/60 cases)and 23.33％(14 cases/60 cases),respectively.The difference was statistically significant(P＜0.05).Conclusion The combination of dobutamine and rhBNP in the treatment of elderly AMI patients with HF can short-term improve cardiac function and related laboratory indexes,enhance myocardial contractility,reduce inflammation and myocardial injury,with good safety.