目的 探討奈西立肽對(duì)老年急性失代償心力衰竭患者心功能及腎功能的影響。方法 2011年1月至2014年6月安徽省第二人民醫(yī)院收治的急性心力衰竭合并腎功能不全患者80例, 隨機(jī)分為治療與對(duì)照兩組, 各40例。在強(qiáng)心、利尿和擴(kuò)血管等基礎(chǔ)上, 對(duì)照組使用小劑量多巴胺(<5 μg/kg)靜脈泵入, 治療組使用奈西立肽、初始劑量2 mg/kg靜脈滴注、之后以0.01 mg/(kg·min)維持, 兩組均連續(xù)治療14 d, 比較兩組治療后心臟功能及腎功能相關(guān)指標(biāo), 并統(tǒng)計(jì)兩組治療后臨床癥狀改善情況。結(jié)果 治療后, 治療組肺毛細(xì)血管楔壓低于對(duì)照組及同組治療前(P<0.05), 左室射血分?jǐn)?shù)和心排血指數(shù)均高于對(duì)照組及同組治療前(P<0.05), 腎小球?yàn)V過率高于對(duì)照組及同組治療前(P<0.05), 尿素氮和肌酐均低于對(duì)照組及同組治療前(P<0.05)。結(jié)論 對(duì)于心衰合并腎功能不全的老年患者, 在強(qiáng)心、利尿和擴(kuò)血管等基礎(chǔ)上, 使用奈西立肽能顯著提高其心臟功能和腎功能, 改善臨床癥狀。

Objective To investigate the effect of nesiritide on the cardiac function and renal function of elderly with acute decompensated heart failure. Methods Eighty cases from January 2011 to June 2014 with acute heart failure and renal dysfunction in the Second People's Hospital in Anhui Province were randomly divided into treatment and control group, 40 cases each. Based on the use of cardiac, diuretic, and vasodilator, the patients in the control group were used low-dose dopamine (< 5 μg/kg) iv infusion, while the patients in the treatment group were iv used nesiritide, with initial dose of 2 mg/kg, followed by 0.01 mg/(kg·min) maintained continuously for 14 d. After the treatment, the cardiac function and renal function indicators and statistical improvement of clinical symptoms between the two groups were compared. Results After the treatment, the pulmonary capillary wedge (PCW) pressure of the patients in the treatment group was lower than that of patients in the control group and the same group before the treatment (P<0.05);The left ventricular ejection fraction and cardiac blood index of the patients in the treatment group were higher than those of patients in the control group and the same group before the treatment (P<0.05); Glomerular filtration rate of patients in the treatment group was higher than that of patients in the control group and the same group before the treatment (P<0.05): Urea nitrogen and creatinine of patients in the treatment group were lower than those in the control group and the same group before the treatment (P<0.05). Conclusion For elderly patients with heart failure and renal insufficiency, the use of nesiritide could significantly improve their heart function and kidney function in clinical symptoms so as to be benefit in cardiac, diuretic, and vasodilator,.