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《Chinese Journal of Difficult and Complicated Cases》 2017-04
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Efficacy and prognosis of recombinant human brain natriuretic peptide in elderly patients with acute decompensated heart failure

ZHANG Huiying;HAO Yanli;LI Yanhui;HUANG Ying;Department of Internal Medicine,Liaoning Jinqiu Hospital;  
Objective To investigate the efficacy and prognosis of recombinant human brain natriuretic peptide in elderly patients with acute decompensated heart failure.Methods Ninety-two cases of elderly patients with acute decompensated heart failure were selected,they were treated in hospital from February 2015 to February 2016,and they were divided into the observation group(46 cases) and control group(46 cases).The patients of two groups were all treated with standard practice for anti-heart failure,include maintaining the smooth flow of the respiratory system,oxygen,low sodium salt diet,correct electrolyte imbalance,and given ACEI,diuretic,cardiac,vasodilators and inotropic drugs.The patients of control group were treated with nitroglycerin(dissolved in 5%sodium chloride solution for intravenous infusion,the initial dose of the first day were 10 μg/rain,increase 5 μg/min in every 5min until 40 μg/min,and keep 5 mg/d continuous intravenous infusion for 4d),and on the basis of the control group,the patients of observation group were treated with recombinant human brain natriuretic peptide(the initial dose was 1.5 μg/kg for intravenous pulse shock treatment,then keep 0.007 5 μg·kg~(-1) · min~(-1)) continuous intravenous infusion for 24 h,and keep 0.5 mg/d(0.007 5 μg · kg~(-1) · min~(-1)) intermittent treatment for 4d.The patients of two groups were all treated for 6 months in a row.The clinical effect,safety evaluation and changes of the levels of LVESD,LVEDD,LVEF,CRP,BNP,24 h urine output of two groups were compared.Results After the appropriate treatment,the patients of the observation group got a total effective rate of 95.7%,which was significantly better than the 82.6%of the control group(x~2 =4.039,P =0.044);The levels of LVESD,LVEDD,CRP,BNP of the observation group were significantly lower than those of the control group(t =2.739,t =2.253,t =3.897,t =5.162,P =0.004,P =0.013,P = 0.002,P =0.000);The levels of LVEF,24 h urine output of the observation group were significantly higher than those of the control group(t =9.722,P =0.000);There were headache,abdominal pain,orthostatic hypotension,elevated serum potassium,elevated transaminase and other adverse reactions occurred in both two groups,but there were no statistically significant between the two groups(x~2 =0.177,x~2 =2.222,x~2 =0.956,X~2 =0.474,x2 = 1.593,P =0.674,P =0.136,P =0.328,P = 0.491,P = 0.207).Conclusion With treating elderly patients with acute decompensated heart failure,recombinant human brain natriuretic peptide can obtain the exact effect,effectively relieve the clinical symptoms,improve the ventricular remodeling,improve the heart function,and it is safe,reliable and conducive to the prognosis of patients.
【CateGory Index】: R541.6
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