重组人脑利钠肽联合多巴胺治疗心力衰竭患者的临床疗效及对脑钠肽、肿瘤坏死因子的影响

王秀峰

[摘要] 目的 探讨重组人脑利钠肽（rhBNP）联合多巴胺治疗心力衰竭（HF）患者的临床疗效及对脑钠肽、肿瘤坏死因子（TNF-α）的影响。 方法 选取我院2018年11月至2020年6月收治的HF患者210例，采用随机数字法将患者分为对照组与观察组，每组各105例。对照组使用静脉滴注硝普钠治疗，观察组在对照组基础上使用rhBNP联合多巴胺进行治疗。比较两组患者的临床治疗疗效，脑钠肽（BNP）、肿瘤坏死因子-α（TNF-α），呼吸困难程度及不良反应发生情况。 结果 观察组患者总有效率（97.14%）高于对照组（82.86%），差异有统计学意义（P<0.05）;两组患者治疗后BNP、TNF-α水平均有改善（P<0.05），且观察组治疗后改善程度更高，差异有统计学意义（P<0.05）。两组患者用药后呼吸困难程度较治疗前改善（P<0.05），且随着用药时间增加改善程度增高，观察组改善程度高于对照组，差异有统计学意义（P<0.05）。两组患者均未出现严重不良反应。 结论 rhBNP联合多巴胺治疗HF患者临床疗效较好，可降低脑钠肽、TNF-α水平，安全性較高，可进一步深入研究。

[关键词] rhBNP;多巴胺;心力衰竭;脑钠肽;肿瘤坏死因子-α

[中图分类号] R953.2          [文献标识码] B          [文章编号] 1673-9701（2021）09-0064-04

Clinical efficacy of rhBNP combined with dopamine on patients with HF and its impact on brain natriuretic peptide and tumor necrosis factor

WANG Xiufeng

Department of Cardiovascular Internal Medicine， Hongda Hospital of Jiamusi University， Jiamusi   154002， China

[Abstract] Objective To explore the clinical efficacy of recombinant human brain natriuretic peptide（rhBNP） combined with dopamine on patients with heart failure（HF） and its impact on brain natriuretic peptide and tumor necrosis factor （TNF-α）. Methods A total of 210 patients with HF admitted to our hospital from November 2018 to June 2020 were collected and were divided into the control group（n=105） and the observation group（n=105） according to the random number table method. Patients in the control group were treated with intravenous drip of sodium nitroprusside， while those in the observation group were treated with rhBNP combined with dopamine on the basis of the control group. The clinical therapeutic efficacy， brain natriuretic peptide （BNP）， TNF-α， degree of dyspnea and adverse reactions of the two groups of patients were compared. Results The total efficacy of the observation group was 97.14%，higher than 82.86% of the control group，with statistically significant difference between the two groups（P<0.05）.The levels of BNP and TNF-α in the two groups of patients were all improved after treatment（P<0.05）， and the improvement degree in the observation group was higher after treatment，with statistically significant difference between the two groups（P<0.05）. After treatment， the degree of dyspnea in the two groups improved after comparison with that before treatment（P<0.05）， and the degree of improvement increased with the increase of medication time，and the improvement degree in the observation group was higher than that in the control group（P<0.05）. There was no serious ADRs between the two groups， and there was no statistically significant difference between the two groups（P>0.05）. Conclusion rhBNP combined with dopamine is more effective in treating patients with HF， which can reduce the levels of BNP and TNF-α and has high safety， which can be further investigated.

[Key words] rhBNP; Dopamine; Heart failure; Brain natriuretic peptide; Tumor necrosis factor-α

心力衰竭（Heart failure，HF）是心脏疾病晚期表现，发病率较高。HF发病机制较复杂，可能是因为患者体内交感神经及肾素-血管紧张素-醛固酮过分激活，且机体缺乏有效对抗神经过度兴奋的神经递质。有研究显示，HF患者体内存在系统性炎性反应，不但可加重心肌损害，激活血小板产生并释放炎性介质，还可造成其他组织器官功能障碍，引起贫血、恶病质等其他疾病[1]。因此如何有效控制患者病情，降低死亡率是临床研究的重点所在。目前在HF患者的诊断中发现，人脑利钠肽（Brain natriuretic peptide，BNP）、多巴胺与心衰程度及左心室功能关系密切，可增加心脏排血量，抑制交感神经活性，是患者强有力的预后因素[2]。研究显示，BNP及多巴胺可通过有效抑制炎症因子释放来改善患者心功能，降低心臟前负荷、避免炎性介质失衡，可作为HF患者治疗随访指标[3]。……