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

Objective: To investigate the clinical efficacy of recombinant human brain natriuretic peptide combined with nicorandil in the treatment of ischemic cardiomyopathy combined with heart failure in elderly patients based on conventional treatment of heart failure.Methods: This article is a prospective clinical study.A total of 123 elderly patients with ischemic cardiomyopathy with heart failure admitted to the department of cardiovascular medicine of the second hospital of Hebei medical university from January 2019 to December 2019 were selected as the study subjects,including 91 male patients and 32 female patients.The age distribution ranged from 60 to 82 years,with an average age of 69.57± 5.88 years.The patients were randomly divided into four groups: the conventional group(30 cases,standardized treatment according to the guidelines),nicorandil group(31 cases,plus nicorandil on the basis of the conventional group treatment),rhBNP group(30 cases,the basis of the conventional group treatment add recombinant human brain natriuretic peptide)and the combined group(32 cases,combined with the addition of recombinant human brain natriuretic peptide and nicorandil on the basis of conventional group treatment).The patients' 6-minute walking distance,the level of serum N-terminal brain natriuretic peptide precursor,left ventricular ejection fraction and left ventricular diameter were recorded before treatment,7 days after treatment and 3 months after treatment,respectively.Results:1.There were no statistically significant differences among the four groups in basic information before treatment,such as age,gender,cardiac function grade,hypertension,diabetes,hyperlipidemia,and history of basic medication(P>0.05).2.Comparison of clinical efficacy indicators among the four groups showed that the number of the times of angina pectoris,the frequency of recurrence of heart failure and the rate of rehospitalizations in the combined group at the third months after treatment were significantly lower than those in the conventional group,nicorandil group and rhBNP group,with statistically significant differences between the groups(P<0.05).At the same time,compared with the conventional group,all indexes of the other three groups were significantly lower than those of the conventional group,and the differences between groups were statistically significant(P<0.05).3.Before treatment,NT-proBNP,6-minute walking test,LVEF and left ventricular diameter of the four groups of patients showed no statistically significant differences(P>0.05).On the 7th day after treatment,NT-proBNP,6-minute walking test,LVEF and left ventricular diameter were significantly improved in the combined group compared with the conventional group,with statistically significant differences(P<0.05).At the third month after treatment,NT-proBNP,6-minute walking test,LVEF and left ventricular diameter were significantly improved in the combined group compared with the conventional group,nicorandil group and rhBNP group,with statistically significant differences(P<0.05).There was a statistically significant difference between the four groups of patients on the 7th day after treatment and on the 3rd month after treatment(P<0.05).4.There were 19 cases of adverse reactions like hypotension,headache and rash in the four groups.The incidence of adverse reactions between the four groups have no statistical difference significantly(?~2=0.712,P=0.870>0.05).Conclusions: The clinical efficacy and cardiac function can be significantly improved in using combined application of recombinant human brain natriuretic in elderly patients with heart failure of ischemic cardiomyopathy,and there is no obvious adverse reactions.