【摘要】 目的 探讨左西孟旦联合重组人脑钠肽（rhBNP）治疗缺血性心肌病患者心力衰竭（心衰）的效果。方法 选取2018年10月至2021年3月于南阳市第二人民医院收治的84例缺血性心肌病合并心衰的患者作为研究对象，采用随机数字表法分为对照组（43例）和观察组（41例），对照组采用左西孟旦治疗，观察组在对照组基础上加用rhBNP。分别于治疗前后检测患者血清N末端脑钠肽前体（NTproBNP）、人和肽素（Copeptin）、大内皮素1(BigET-1)、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、胸腔内血容量指数（ITBVI）、全心舒张末期容量指数（GEDVI）和血管外肺水指数（EVLWI），观察并记录患者不良反应的发生情况，统计治疗总有效率。结果 治疗后两组患者LVEDD、LVESD、血清NT-pro BNP、Copeptin、BigET-1均较治疗前降低，且观察组低于对照组（P<0.05）;LVEF较治疗前升高，且观察组高于对照组（P<0.05）；给药12 h和24 h后，观察组ITBVI、GEDVI和EVLWI均低于对照组（P<0.05）；观察组血清载脂蛋白B(APOB)、载脂蛋白A-I(APOA-I)水平以及APOB/APOA-I比值低于对照组（P<0.05）。观察组治疗有效率高于对照组（P<0.05），两组不良反应发生率比较，差异无统计学意义（P>0.05）。结论 左西孟旦联合rhBNP可降低ITBVI、Copeptin水平，改善患者血流动力学，提高心功能水平，安全有效。更多还原

【Abstract】 Objective To investigate the therapeutic effect of levosimendan(Levo) combined with recombinant human brain natriuretic peptide(rhBNP) in patients with ischemic cardiomyopathy(ICM). Methods The patients with ICM complicated by heart failure(HF, n=84) were chosen from the Second People’s Hospital of Nanyang City from Oct. 2018 to Mar. 2021, and divided, according to random digital table, into control group(n=43) and observation group(n=41). The control group was treated with Levo, and observation group was treated with Levo and rhBNP. Before and after treatment, the indexes of N-terminal pro-brain natriuretic peptide(NT-proBNP), Copeptin, big endothelin-1(BigET-1), left ventricular ejection fraction(LVEF), left ventricular end-diastolic inner diameter(LVEDD), left ventricular end-systolic diameter(LVESD), intrathoracic blood volume index(ITBVI), global end-diastolic volume index(GEDVI) and extravascular lung water index(EVLWI) were detected in 2 groups. The incidence of adverse reactions were observed and recorded, and the total effective rate was statistically treated in 2 groups during the treatment. Results After treatment, the indexes of LVEDD, LVESD, NT-pro BNP, Copeptin and BigET-1 decreases in 2 groups, which were lower in observation group than those in control group(P<0.05), LVEF increased, which was higher in observation group than that in control group(P<0.05). After treatment for 12 h and 24 h, the indexes of ITBVI, GEDVI and EVLWI were all lower in observation group than those in control group(P<0.05), and levels of apolipoprotein B(APOB), apolipoprotein A-I(APOA-I) and APOB to APOA-I ratio were lower in observation group than those in control group(P<0.05). The effective rate was higher in observation group than that in control group(P<0.05), and difference in the incidence rates of adverse reactions had no statistical significance between 2groups(P>0.05). Conclusion Levo combined with rhBNP can reduce the levels of ITBVI and Copeptin, improve hemodynamics and promote heart function in patients with ICM complicated by HF, and it is safe and effective.更多还原