目的 探讨基于NT-proBNP目标导向的治疗方案对慢性心力衰竭患者近期预后及再住院的影响.方法 将194例慢性心力衰竭患者随机分为NT-proBNP目标导向组(观察组)和经治医生自行决定出院组(对照组),NT-proBNP治疗标准为较入院时降低30％以上.研究者只需按照规范化心力衰竭治疗方案对患者进行治疗,研究本身不设定特定的治疗方案,观察2组患者出院3个月内的再入院率、病死率,入组时、出院后3个月超声心动图检查左心室射血分数(LVEF)、心脏指数(CI)、心排血量(C0)、每搏排血量(SV),并检查2组患者血浆N端脑钠肽前体(NT-proBNP)水平.结果 观察组患者出院3个月内再入院率、病死率均显著低于对照组(P均＜0.05).入组时,2组LVEF、CI、CO、SV、NT-proBNP比较差异均无统计学意义(P均＞0.05).出院后3个月,2组LVEF、CI、CO、SV均显著优于入组时(P均＜0.05),且观察组优于对照组(P均＜0.05);2组的NT-proBNP均显著低于入组时(P均＜0.05),且观察组下降得更明显(P＜0.05).结论 基于BNP目标导向执行NT-proBNP动态监测对指导慢性心力衰竭患者的临床用药、评价预后均具有重要的临床价值.%Objective It is to investigate the effect of N-terminal brain natriuretic peptide precursor (NT-proBNP) target-oriented treatment regimen on short-term prognosis and rehospitalization in patients with chronic heart failure.Methods 194 patients with chronic heart failure were randomly divided into NT-proBNP target group (observation group) and physician decided to discharge group (control group),NT-proBNP treatment criteria for admission was more than 30％ or more.Researchers only need to follow the standardized treatment of heart failure treatment of patients,the study itself did not set a specific treatment program to observe the two groups of patients discharged within 3 months of re-admission rate,mortality,into the group,after discharge 3 months left ventricular ejection fraction (LVEF),cardiac index (CI),cardiac output (CO),stroke volume (SV) were measured by echocardiography.And the levels of NT-proBNP in the plasma of the two groups were examined.Results The hospitalization rate and mortality were significantly lower in the observation group than those in the control group (P ＜ 0.05).There was no significant difference in LVEF,CI,CO,SV between the two groups (P ＞ 0.05).At 3 months after discharge,LVEF,CI,CO and SV in the control group and the observation group were significantly better than those before treatment in each group (P ＜ 0.05),and the improvements in the observation group were better than those in the control group (P ＜ 0.05).There was no significant difference in the NT-proBNP between the two groups before treatment(P ＞0.05).The levels of NT-proBNP at 3 months after discharge of the control group and the observation group were significantly lower than those before therapy (P ＜ 0.05),and the decreases in the observation group were more significant than those in the control group (P ＜ 0.05).Conclusion Based on BNP target-oriented implementation of NT-proBNP dynamic monitoring,it has important clinical value to evaluate the prognosis of patients with chronic heart failure.
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