目的 探討參附注射液聯(lián)合凍干重組人腦利鈉肽治療硝酸鹽干預(yù)后效果不佳擴(kuò)張型心肌病的臨床療效。方法 選取天津市第四醫(yī)院2013年2月-2015年10月收治的硝酸鹽干預(yù)效果不佳擴(kuò)張型心肌病患者90例,所有患者按照隨機(jī)數(shù)字表格法分為3組,每組各30例。參附注射液組靜脈滴注參附注射液,40 mL加入葡萄糖注射液250 mL中,1次/d。重組人腦利鈉肽組給予凍干重組人腦利鈉肽,先靜脈推注1.5 μg/kg,90 s內(nèi)推注完,隨后加以凍干重組人腦利鈉肽7.5 ng/(kg·min)持續(xù)泵入48 h。聯(lián)合用藥組行參附注射液聯(lián)合凍干重組人腦利鈉肽治療,其中參附注射液、重組人腦利鈉肽治療方案同上。3組患者均連續(xù)治療10 d。觀察3組的臨床療效,同時比較3組治療前后心功能指標(biāo)、6 min步行距離、血漿鈉尿肽(BNP)和高敏C反應(yīng)蛋白(hs-CRP)水平。結(jié)果 3組總有效率分別為86.7%、83.3%、93.3%,聯(lián)合用藥組總有效率高于其他兩組,但是3組總有效率比較差異無統(tǒng)計學(xué)意義。治療后,3組左心室射血分?jǐn)?shù)(LVEF)、6 min步行距離明顯升高,左心室舒張末內(nèi)徑(LVEDD)明顯縮小,同組治療前后比較差異具有統(tǒng)計學(xué)意義(P<0.05);聯(lián)合用藥組LVEF、6 min步行距離均明顯高于參附注射液組和重組人腦利鈉肽組,3組比較差異具有統(tǒng)計學(xué)意義(P<0.05)。治療后,3組血漿BNP、hs-CRP水平明顯下降,同組治療前后比較差異具有統(tǒng)計學(xué)意義(P<0.05);且聯(lián)合用藥組的這些指標(biāo)下降幅度明顯大于參附注射液組和重組人腦利鈉肽組,3組比較差異具有統(tǒng)計學(xué)意義(P<0.05)。結(jié)論 參附注射液聯(lián)合重組人腦利鈉肽治療硝酸鹽干預(yù)后效果不佳擴(kuò)張型心肌病具有較好的臨床療效,能夠改善心功能,降低血漿BNP、hs-CRP水平,具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical curative effects of Shenfu Injection combined with Lyophilized Recombinant Human Brain Natriuretic Peptide in treatment of dilated cardiomyopathy with poor nitrate intervention. Methods Patients (90 cases) with dilated cardiomyopathy with poor nitrate intervention in the Fourth Hospital of Tianjin from February 2013 to October 2015 were divided into three groups according to the random number table method, and each group had 30 cases. The patients in the Shenfu Injection group were iv administered with Shenfu Injection, 40 mL added intoglucose injection 250 mL, once daily. The patients in the recombinant human brain natriuretic peptide (rhBNP) group were given Lyophilized Recombinant Human Brain Natriuretic Peptide, first intravenous injection 1.5 μg/kg in 90 s, then continuously pumped with dosage of 7.5 ng/(kg·min) for 48 h. The patients in the combined group were treated with Shenfu Injection combined and Lyophilized Recombinant Human Brain Natriuretic Peptide. The patients in three groups were treated for 10 d. After treatment, the clinical efficacies were evaluated, and cardiac function indexes, 6 min walking distance, blood BNP, and hs-CRP in three groups before and after treatment were compared. Results After treatment, the efficacies were 86.7%, 83.3%, and 93.3%, respectively, and the efficacy in the combined group was higher than those in other groups, but there was no significant difference among three groups. After treatment, LVEF and 6 min walking distance in three groups were significantly increased, LVEDD were obviously shortened, blood BNP, and hs-CRP were significantly decreased, and the differences were statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the combined group were significantly better than those in the Shenfu Injection and rhBNP groups, with significant difference between two groups (P < 0.05). Conclusion Shenfu Injection combined with Lyophilized Recombinant Human Brain Natriuretic Peptide has clinical curative effect in treatment of dilated cardiomyopathy with poor nitrate intervention, can significantly improve cardiac function, and can significantly decrease BNP and hs-CRP levels, which has a certain clinical application value.