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依据B型钠尿肽水平调整急性冠脉综合征患者β受体阻滞剂使用的临床研究 预览 被引量:4

Clinical research of beta receptor blocker in acute coronary syndrome patients based on the level of B-type natriuretic peptide
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摘要 目的 探讨不同B型钠尿肽(BNP)水平下急性冠脉综合征(ACS)患者使用β受体阻滞剂的安全性。方法 依据入院后即时BNP水平将231例ACS患者分3组:对照组(〈100μg/L)64例、灰带组(100~400μg/L)78例、升高组(〉400μg/L)89例。三组患者给予ACS常规治疗及初始剂量的β受体阻滞剂6.25 mg,每日2次。观察记录三组患者BNP浓度变化,血压、心率、心律、killip心功能分级,以及是否并发胸腔积液、下肢水肿和急性左侧心力衰竭。依据各组患者观察治疗期间出现的病情变化不同将其分为A、B和C事件,并根据不同事件确定是否继续使用β受体阻滞剂及其用量。结果 三组间A事件和C事件发生率差异均有统计学意义(χ2=28.528、32.608,P均〈0.001),其中对照组A事件发生率最低,升高组A事件发生率最高;C事件在对照组中发生率最高,在升高组中发生率最低(P均〈0.017)。三组胸腔积液发生率差异有统计学意义,对照组最低,升高组最高(F=35.408,P〈0.001)。而下肢水肿的发生数三组相比差异没有统计学意义(χ2=2.973,P=0.226)。对照组β受体阻滞剂使用量最大,升高组最低,三组间差异有统计学意义(F=8.670,P〈0.001)。结论 ACS患者BNP水平越高,发生严重不良事件以及心功能下降和胸腔积液的风险也越高,依据BNP水平调整β受体阻滞剂使用剂量可以降低ACS患者并发症和严重不良事件的发生率。 Objective To investigate the safety of beta receptor blocker in acute coronary syndrome (ACS) patients based on the level of B-type natriuretic peptide (BNP). Methods A total of 231 ACS patients were classified into three groups according to their BNP level:: control group (BNP 〈 100 p,g / L, n = 64), medium group (BNP 100 to 400 μg / L, n = 78) and high level group (BNP 〉 400 μg/L, n = 89). All patients were treated with routine therapy plus beta receptor blocker (6.25 mg each time, twice a day). The BNP level, blood pressure, heart rate, heart rhythm, killip heart function classification, the occurrence of pleural effusions, lower limb edema and acute left heart failure were recorded. And the above indexes were divided into A, B, C events based on the disease evolution of patients in each group during the treatment, and according to the different events to determine whether to continue the use of beta receptor blockers and dosage. Resultls The occurrence rate of A and C events showed significant differences among the three groups (χ2=28.528, 32.608, all P〈0.001), and the control group had a lowest occurrencerates of A event but a highest occurrence rates of C event, while the high level group had a highest occurrence rates of A event but a lowest occurrence rates of C event (all P 〈 0.017). The occurrence rate of pleural effusions has a significant difference among the three groups (F = 35.408, P〈0.001), and it is highest in the high level group, but is lowest in the normal group. However, there were no significancet differences in the occurrence of lower limb edema among the three groups (χ2 = 2.973, P= 0.226). And the beta-blockers usage in the control group were highest, and it decreased most in the high level group (F= 8.670, P〈 0.001). Conclusions The higher level of BNP in ACS patients is correlated with the occurrence of pleural effusions and decreased heart function. The evaluation of BNP level is a guide to the use of beta receptor blocker
作者 郭明 杨杰 张亚梅 郑霞飞 张宗辉 蒋国军 Guo Ming, Yang Jie, Zhang Yamei, Zheng Xiafei, Zhang Zonghui, Jiang Guojun. (Department of Cardiology, Zhejiang Xiaoshan Hospital, Hangzhou 311202, China)
出处 《中华危重症医学杂志(电子版)》 2015年第5期296-299,共4页
基金 杭州市科技发展计划项目(20130733Q42)
关键词 急性冠脉综合征 肾上腺素能Β受体拮抗剂 B型钠尿肽 Acute coronary syndrome Adrenergic beta-antagonists B-type natriuretic peptide
作者简介 通信作者:郭明,Email:guoming@zjsh.com
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