Clinical Efficacy Of Recombinant Human Brain Natriuretic Peptide Combined With Levosimendan In The Treatment Of Ischemic Cardiomyopathy With Heart Failure

Background and ObjectiveWith the increasing aging of the social population and the continuous progress of urbanization,as well as the tremendous changes in the way of life of the residents,the fatality rate of the elderly diseases,especially cardiovascular diseases,increases with the increase of age.The harm to human health is becoming more and more serious,which seriously threatens the quality of life of people in our country.With the rapid development of thrombolytic therapy,percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG),the survival rate of patients with acute myocardial infarction(AMI)continues to increase.However,the incidence of left ventricular remodeling and chronic myocardial dysfunction increased,so that ischemic cardiomyopathy patients were significantly increased,and become a thorny problem in clinical treatment.Heart failure is an inevitable manifestation of ischemic cardiomyopathy at a certain stage.Ischemic cardiomyopathy complicated with heart failure often indicates poor prognosis.On the basis of full evaluation,it is necessary to use a variety of comprehensive treatment methods,manage patients scientifically and effectively and improve the prognosis of patients.Optimal drug treatment is the basis for patients with ischemic cardiomyopathy combined with heart failure.Recombinant human brain natriuretic peptide(rhBNP)is a new generation of drugs for the treatment of heart failure.It is a synthetic endogenous peptide,which can dilate blood vessels,diuresis,natriuresis and effectively reduce the preload and afterload of heart.It can inhibit the action of renin-angiotensin-aldosterone system and sympathetic nervous system,at the same time,it can improve the blood supply of coronary artery,alleviate the cause of ischemia,and has no positive inotropic effect,and does not increase the oxygen consumption of myocardium.Levoximendan is a calcium sensitizer with positive inotropic,vasodilating and cardioprotective effects.Although the level of medical treatment is improving,the morbidity and mortality of ischemic cardiomyopathy have not decreased obviously,so the prevention and treatment of ischemic cardiomyopathy has become the focus,difficulty and hotspot of medical research.The aim of this study was to observe the clinical efficacy of recombinant human brain natriuretic peptide combined with levosimendan in the treatment of ischemic cardiomyopathy with heart failure on the basis of traditional therapy for heart failure.Materials and methods1 Research object: 120 patients with ischemic cardiomyopathy who were hospitalized in Department of Cardiology,the Second Affiliated Hospital of Zhengzhou University from 2017-01-01 to 2018-06-30 were selected.During hospitalization,the patient’s sex,age,smoking,diabetes,hypertension,hyperlipidemia and type of medication were recorded in detail,plasma levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)were measured,echocardiography was performed and left ventricular ejection fraction(LVEF)were recorded.2 Grouping method: It was divided into four groups(30 cases each)by random digital table method.All the 4 groups were treated with routine basic therapy,Group A was treated with recombinant human brain natriuretic peptide and levosimendan on the basis of routine treatment,group B was treated with levosimendan on the basis of routine therapy,group C was treated with recombinant human brain natriuretic peptide on the basis of routine therapy,group D was given routine basic therapy only.The observation period of the four groups was 10 days.The changes of N-terminal pro-brain natriuretic peptide(NT-proBNP),six minutes walking test,left ventricular ejection fraction(LVEF)and adverse drug reactions were observed and compared before and after treatment.3 Statistical methods: Statistical analysis was carried out with SPSS 20.0 software.The count data was represented by the frequency(composition ratio),and the chi-square test,Bonferroni correction and Fisher’s exact probabilities were used for comparison between groups.The measured data were expressed as mean±standard deviation(?x±s),paired t-test,one-way ANOVA and LSD-t test were used respectively.P<0.05 was statistically significant.Result(1)Sex ratio,age,smoking rate,diabetes,hypertension and hyperlipidemia and heart function grade of NYHA of four groups of patients showed no significant difference(P>0.05).(2)The total effective rate of group A was 90.0%,the total effective rate of group B was 80.0%,the total effective rate of group C was 76.7%,the total effective rate of group D was 40.0%,the difference of the total effective rate among the four groups was statistically significant(P<0.05).Multiple comparisons were made under the testing level of Bonferroni correction,there was no statistically significant difference among the three groups A,B and C(P>0.0083),and there were significant differences between Group A,B,C and Group D respectively(P>0.0083).(3)Before treatment,there were no statistically significant differences in NT-proBNP,LVEF and six minutes walking test between the four groups(P>0.05).After treatment,the levels of NT-proBNP decreased,the level of LVEF increased and the walking distance of six minutes increased in the four groups,which were significantly improved compared with those before treatment(P<0.05).The improvement range of each indicator in group A was significantly better than that in groups B,C and D(P<0.05),and that in groups B,C was significantly better than that in group D(P<0.05),but there was no significant difference between group C and group B(P>0.05).(4)Four groups of patients experienced different degrees of adverse reactions during the treatment,including hypotension,headache,ventricular tachycardia,nausea,vomiting.After adjusting the speed of intravenous administration or stopping medication,relieving pain and easing vomit,the symptoms improved and continued treatment was given.The incidence of adverse reactions in group A was 10.0%,6.7% in group B,13.3% in group C,and 3.3% in group D.There was no significant difference in the incidence of adverse reactions between the four groups(P>0.05).ConclusionThe combined use of recombinant human brain natriuretic peptide and levosimendan on the basis of conventional treatment of heart failure can significantly improve the clinical efficacy and cardiac function in patients with heart failure of ischemic cardiomyopathy,and there were no severe adverse reactions.