B型钠尿肽的临床意义讲课稿.ppt

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2020-08-09 发布于天津
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B型钠尿肽的临床意义讲课稿.ppt

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Hemodynamic Effects of Nesiritide vs Placebo vs IV NTG * ? * ? * ? ? ? ? ? * Publication Committee for the VMAC Investigators. JAMA. 2002;287:1531 During 3-hr placebo period Placebo n = 62 IV NTG n = 60 Nesiritide n = 124 After 3-hr period IV NTG n = 92 Nesiritide n = 154 * P ? 0.05 vs placebo ? P ? 0.05 vs IV NTG PCWP – Placebo PCWP – IV NTG PCWP – Nesiritide End of Placebo-Controlled Period Time on Study Drug (hr) 00.25 0.5 1 2 3 6 9 12 24 36 48 – 9 – 8 – 7 – 6 – 5 – 4 – 3 – 2 – 1 0 ? * * C h a n g e F r o m B a s e l i n e i n P C W P ( m m H g ) VMAC: Dyspnea Improvement *Added to standard care Publication Committee for the VMAC Investigators. JAMA. 2002;287:1531 Dyspnea at 3 hr P r o p o r t i o n o f S u b j e c t s ( % ) Nitroglycerin* (n = 143) Nesiritide* (n = 204) Placebo * (n = 142) ? 40 ? 30 ? 20 ? 10 0 10 20 30 40 50 60 70 80 90 100 P =0.191 P =0.034 Markedly better Moderately better Minimally better No change Minimally ? markedly worse No Change Minimally- Markedly Worse Minimally Better Moderately Markedly # No Change Minimally- Markedly Worse No Change Minimally- Markedly Worse Minimally Better Moderately Better Markedly Better 5 Mins 1 Hour 3 Hours # No Change Minimally- Markedly Worse ? No Change Minimally- Markedly Worse Minimally Better Moderately Better Markedly Better 5 Mins 1 Hour 3 Hours # No Change Minimally- Markedly Worse ? or nitroglycerin compared to placebo ompared to nitroglycerin No Change Minimally- Markedly Worse Minimally Better Moderately Better Markedly Better 5 Mins 1 Hour 3 Hours # No Change Minimally- Markedly Worse ? or nitroglycerin compared to placebo red to nitroglycerin No Change Minimally- Markedly Worse Minimally Better Moderately Better Markedly Better ns 1 Hour 3 Hours # No Change Minimally- Markedly Worse （二） BNP 和急性心肌梗死（ 1 ）双峰：第 1 峰 —— 心梗后第 (16.4 ± 0.7)h BNP(319 ± 58)pg/ml 第 2 峰 —— 心梗后第 5 天 BNP(277 ± 66)pg/ml （ 2 ）单峰：心梗后第 (16.4 ± 0.7)h BNP 变化形式形成机制心肌缺血早期