目的 探讨奈西立肽对老年急性失代偿心力衰竭患者心功能及肾功能的影响。方法 2011年1月至2014年6月安徽省第二人民医院收治的急性心力衰竭合并肾功能不全患者80例, 随机分为治疗与对照两组, 各40例。在强心、利尿和扩血管等基础上, 对照组使用小剂量多巴胺(<5 μg/kg)静脉泵入, 治疗组使用奈西立肽、初始剂量2 mg/kg静脉滴注、之后以0.01 mg/(kg·min)维持, 两组均连续治疗14 d, 比较两组治疗后心脏功能及肾功能相关指标, 并统计两组治疗后临床症状改善情况。结果 治疗后, 治疗组肺毛细血管楔压低于对照组及同组治疗前(P<0.05), 左室射血分数和心排血指数均高于对照组及同组治疗前(P<0.05), 肾小球滤过率高于对照组及同组治疗前(P<0.05), 尿素氮和肌酐均低于对照组及同组治疗前(P<0.05)。结论 对于心衰合并肾功能不全的老年患者, 在强心、利尿和扩血管等基础上, 使用奈西立肽能显著提高其心脏功能和肾功能, 改善临床症状。

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,.