重组人脑钠尿肽治疗急性失代偿心力衰竭中不同水钠潴留程度患者的疗效

目的: 比较静脉注射重组人脑钠尿肽(recombinant human brain natriuretic peptide,rhBNP)对伴有不同水钠潴留程度的急性失代偿心力衰竭（ADHF）患者的血流动力学作用及临床疗效。方法: 我院40例ADHF住院患者按水钠潴留程度分为试验组（中重度者,20例）和对照组（轻度者,20例）,各组再随机抽取10例应用Swan-Ganz导管进行血流动力学监测,记录给药前及给药后0.5、1、3、6及24 h肺毛细血管楔压(PCWP)、肺动脉压(PAP)和右房压(RAP)并通过热敏稀释法测定心排出量（CO）,计算心脏指数(CI)。所有患者均给抗心力衰竭治疗并给予rhBNP,首先以2 μg/kg静脉冲击,随后以0.01 μg/(kg·min)连续静脉滴注24 h,记录两组患者给药前及给药后0.5、1、3、6及24 h的呼吸困难及整体临床状况改善程度,以及用药后24 h液体出入量。结果: 与对照组比较,试验组患者呼吸困难及整体临床状况改善更明显,并伴随更佳的利尿作用［（2.7±0.8） L vs. （1.7±0.4） L,P=0.01］。试验组PCWP及RAP下降较迅速、明显且稳定持久,两组间PAP比较无统计学差异。两组CI比较组内及组间均无明显统计学差异。结论: 伴有中重度水钠潴留的ADHF患者较伴有轻度水钠潴留的患者应用rhBNP治疗有更好的急性血流动力学效应和临床效果,可能是rhBNP临床使用的最佳人群。     

冻干重组人脑利钠肽联合呋塞米治疗老年急性心肌梗死合并心力衰竭的临床研究

目的探讨冻干重组人脑利钠肽联合呋塞米治疗老年急性心肌梗死合并心力衰竭的疗效及对肾上腺素(E)、去甲肾上腺素(NE)、肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(Ald)水平的影响。方法选择2016年2月—2018年2月我院收治的老年急性心肌梗死合并心力衰竭病人160例,根据治疗方案分为观察组和对照组,对照组给予呋塞米治疗,观察组在对照组基础上联合冻干重组人脑利钠肽治疗。检测两组治疗前后E、NE、PRA、AngⅡ、Ald水平;收缩压、心率及血氧饱和度水平;两组均行心动图检查,测量左室舒张末期内径(LVDD)、左室射血分数(LVEF)。结果治疗6 h及24 h,两组E、NE、PRA、AngⅡ、Ald水平均降低,且观察组均低于对照组(P0.05);停药6 h,两组E、NE、PRA、AngⅡ、Ald水平均有所回升,但低于治疗前(P0.05),且观察组均低于对照组(P0.05)。治疗后,两组收缩压、心率及血氧饱和度均改善(P0.05),且观察组收缩压、心率低于对照组(P0.05),血氧饱和度高于对照组(P0.05)。治疗后,两组LVEF升高(P0.05),且观察组高于对照组(P0.05)。结论冻干重组人脑利钠肽联合呋塞米治疗急性心肌梗死合并心力衰竭疗效显著,可能与降低E、NE、PRA、AngⅡ、Ald神经内分泌激素有关。     

肾动脉射频消融对远期高血压及心脏重构的影响

目的 观察肾动脉射频消融（renal sympathetic denervation,RSD）对远期高血压以及心脏重构的影响。方法 采用腹主动脉缩窄建立压力负荷性高血压兔模型,建模2个月进行RSD,术后2个月测定血压、左室质量指数（LVMI）、心肌胶原容积分数,以及血浆中去甲肾上腺素(NE)、精氨酸血管加压素(AVP)、血管紧张素Ⅱ(AngⅡ)、醛固酮(Ald)的变化。结果 RSD 2个月后,高血压+射频组的血压低于高血压组（P<0.05）。与假手术组比较,高血压组左室后壁厚度（LVPWT）、室间隔厚度（IVST）、LVMI明显增加（P<0.05）,与高血压组比较,高血压+射频组上述数值明显下降（P<0.05）。心肌胶原容积分数（CVF）在高血压组是升高的,经消融后也得以降低（P<0.05）。高血压组NE、AngⅡ、Ald和AVP较假手术组明显升高（P<0.05）,RSD后NE、AVP较高血压组明显下降（P<0.05）,但Ald、AngⅡ无显著差异。结论 RSD可以降低压力负荷导致的血压升高,降低了心脏的肥厚程度和心肌纤维化。     

美托洛尔对充血性心力衰竭患者神经内分泌活性及心功能的影响

目的 :观察美托洛尔对应用血管紧张素转换酶抑制剂 (ACEI)等基础治疗的充血性心力衰竭 (CHF)患者神经内分泌激活及心功能的影响 ,探讨其治疗CHF的机制。方法 :入选的 95例CHF患者均接受基础治疗(洋地黄、利尿剂、ACEI)。并随机分为治疗组和对照组 ,治疗组加用美托洛尔 ,随访至 6个月时治疗组为 5 7例 ;对照组 2 6例。并分别于治疗前和治疗后 1、3、6个月测定血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )和去甲肾上腺素 (NE)水平。结果 :治疗组应用美托洛尔后PRA、NE明显下降 ,同治疗前相比二者均P <0 .0 1;而对照组PRA、AngⅡ、NE与基线相比均明显升高 (P <0 .0 1,P <0 .0 1,P <0 .0 5 )。美托洛尔组同对照组相比 ,对神经内分泌的抑制加强 ,同时伴有左室射血分数 (LVEF)的升高。结论 :单纯ACEI等基础治疗仍存在PRA、AngⅡ和NE等神经内分泌的激活 ,美托洛尔可抑制神经内分泌的激活 ,同时伴LVEF的升高     

慢性心力衰竭一氧化氮和血管紧张素Ⅱ浓度的变化及其相互关系

目的：探讨一氧化氮（N0）和血管紧张素Ⅱ（AngⅡ）在慢性心力衰竭（CHF）患者中的变化，及其与心功能的相互关系。方法：选取CHF患者60例及正常人30例，检测NO、AngⅡ水平及左室射血分数（LVEF），进行组问比较及相关分析。结果：（1）CHF组NO、AngⅡ水平明显高于正常对照组，而LVEF水平相反（P〈0．01）；（2）随着心功能减退，NO、AngⅡ水平逐渐升高（P〈0．01或〈0．05）；（3）收缩性与舒张性心力衰竭之间NO、AngⅡ水平差异无统计学意义（P〉0．05）；（4）LVEF与NO、AngⅡ呈负相关（r=-0．415，-0．544，P〈0．01）。结论：NO、AngⅡ参与了CHF形成的病理生理过程，且与CHF的严重程度有关。     

冠心病患者血浆肾素-血管紧张素Ⅱ-醛固酮活性变化及临床意义

目的检测冠心病患者血浆肾素-血管紧张素Ⅱ-醛固酮活性,并通过活性的变化探讨其在冠心病发生发展过程中的临床意义。方法采用放射免疫法检测稳定型心绞痛患者(A组,17例),不稳定型心绞痛患者(B组,15例)及心肌梗死患者(C组,20例),健康者(对照组,18例)的血浆肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(Ald)活性。结果A、B、C组血浆PRA、AngⅡ、Ald均明显高于对照组(P<0.05或P<0.01);C组血浆PRA、AngⅡ、Ald高于A、B组(P<0.05或P<0.01),B组血浆PRA、AngⅡ、Ald高于A组(P<0.05或P<0.01),差异均有统计学意义。结论冠心病患者肾素-血管紧张素-醛固酮系统(RAAS)被激活,且与病情严重程度相一致。     

冠心病患者血浆肾素-血管紧张素Ⅱ-醛固酮活性变化及临床意义

目的 检测冠心病患者血浆肾素-血管紧张素Ⅱ-醛固酮活性,并通过活性的变化探讨其在冠心病发生发展过程中的临床意义.方法 采用放射免疫法检测稳定型心绞痛患者(A组,17例),不稳定型心绞痛患者(B组,15例)及心肌梗死患者(C组,20例),健康者(对照组,18例)的血浆肾素(PRA)、血管紧张素Ⅱ(Ang Ⅱ)、醛固酮(Ald)活性.结果 A、B、C组血浆PRA、Ang Ⅱ、Ald均明显高于对照组(P＜0.05或P＜0.01);C组血浆PRA、Ang Ⅱ、Ald高于A、B组(P＜0.05或P＜0.01),B组血浆PRA、Ang Ⅱ、Ald高于A组(P＜0.05或P＜0.01),差异均有统计学意义.结论 冠心病患者肾素-血管紧张素-醛固酮系统(RAAS)被激活,且与病情严重程度相一致.     

伊贝沙坦联合培哚普利治疗充血性心力衰竭临床观察

目的探讨伊贝沙坦联合培哚普利治疗充血性心力衰竭（CHF）的临床疗效及其对神经内分泌激素的作用。方法CHF患者60例随机分成治疗组和对照组。治疗组30例给予伊贝沙坦（Irb）150mg/d,培哚普利（Pe）4mg/d;对照组给予培哚普利4mg/d及安慰剂治疗。两组基础治疗类同,疗程6个月。观察治疗前后两组患者的临床症状,超声心动图记录心功能指标,测定血管紧张素Ⅱ（AngⅡ）,醛固酮（ALD）,血浆肾素活性（PRA）和心房钠尿肽（ANP）水平及不良反应。结果两组治疗前后相比,左室射血分数（LVEF）,每搏量（SV）,心脏指数（CI）均有显著改善（P<0.01）。AngⅡ、ALD、ANP显著降低（P<0.01）,PRA显著升高（P<0.01）。治疗组LVEF、CI及ANP的改善优于对照组（P<0.05）。结论伊贝沙坦联合培哚普利治疗CHF可以增强疗效。     

慢性心力衰竭患者血红蛋白、血清肿瘤坏死因子和血管紧张素Ⅱ水平的变化及其关系的研究

目的:研究慢性心力衰竭(CHF)患者血红蛋白(Hb)、血清肿瘤坏死因子(TNF)-α和血管紧张素Ⅱ(AngⅡ)水平的变化及其之间的关系。方法:对入选的121例CHF患者(CHF组)和27例正常人(对照组)(均海拔2260m)测定了Hb、血清TNF-α和AngⅡ水平,超声心动图测量左室射血分数(LVEF),按Hb水平将CHF患者分为贫血组和非贫血组。结果:CHF患者Hb水平降低,而血清TNF-α和AngⅡ水平增高,与对照组比较均差异有统计学意义(均P<0.01);随着心功能恶化,Hb水平逐渐降低,而血清TNF-α和AngⅡ水平逐渐升高;贫血组患者血清TNF-α和AngⅡ水平明显增高,与非贫血组比较均差异有统计学意义(均P<0.01);随着Hb水平降低,CHF患者血清TNF-α和AngⅡ水平逐渐升高;CHF患者Hb水平与TNF-α和AngⅡ水平呈负相关(P<0.01)。结论:CHF患者Hb水平降低、TNF-α和AngⅡ水平的升高与CHF恶化有关,Hb水平与TNF-α和AngⅡ水平呈负相关。     

重组人脑利钠肽和硝酸甘油治疗急性失代偿性心力衰竭疗效和安全性的随机、开放、平行对照的多中心临床研究

目的比较重组人脑利钠肽和硝酸甘油治疗急性失代偿性心力衰竭(心衰)的治疗效果和安全性。方法试验对入选的209例急性失代偿性心衰患者的临床资料采用随机、开放、平行对照、多中心方法进行采集和统计分析。入选患者随机分配为导管组和非导管组,导管组应用Swan-Ganz导管进行血流动力学监测,分别在给药的0、15、30min和1、2、4、8、12、24h结束时测量记录治疗前后的肺毛细血管楔压(PCWP)、肺动脉压(PAP),分别于给药的1、4、8、24h测量右房压(RAP)、心排量(CO)和心排指数(CI)。导管组与非导管组均记录治疗前后的呼吸困难程度、出入量以及全身临床情况评估。分组后患者再随机分入试验组(重组人脑利钠肽)和对照组(硝酸甘油),试验组使用重组人脑利钠肽首先以0·15μg/kg静脉冲击后,以0·0075μg·kg-1·min-1连续静脉滴注;对照组静脉持续滴注硝酸甘油。安全性评估采用用药过程中及用药后定期测量血压、心率,并对过程中所有不良事件进行记录。结果试验资料显示,两组治疗期间的液体出量均显著增加;试验组的呼吸困难和临床状况好转率显著优于对照组;试验组的PCWP、PAP比对照组有显著下降,而两组RAP和CI差异无统计学意义。在与药物相关的不良事件方面,两组差异无统计学意义。结论重组人脑利钠肽能明显改善急性失代偿性心衰患者的血流动力学、呼吸困难程度及全身临床状况,在有效降低PCWP方面优于硝酸甘油,其安全性与硝酸甘油类似。     

重组人脑利钠肽治疗慢性心力衰竭对醛固酮及内皮素-1的影响

目的:评价重组人脑利钠肽(rhBNP)治疗慢性心力衰竭的疗效及对血浆醛固酮和内皮素-1水平的影响。方法:对35例入选患者进行随机、开放、对照临床试验。其中实验组18例,给予rhBNP治疗;对照组17例,给予硝酸甘油治疗;观察两组用药前后血流动力学指标及血浆K 、Na 、醛固酮(ALD)和内皮素-1(ET-1)水平的变化,来探讨rhBNP治疗慢性心力衰竭的疗效及作用机制。结果:实验组在降低患者肺毛细血管楔压和肺动脉压方面、降低血浆醛固酮和内皮素-1浓度方面、升高K 浓度、降低Na 浓度方面与对照组比较均有统计学差异(P均<0．05-0．01)。结论:rhBNP治疗慢性心力衰竭疗效显著,其作用机制可能与拮抗肾素-血管紧张素-醛固酮系统的过度激活,抑制内皮素-1的释放有关,是一种既可以改善血流动力学指标,又可以拮抗神经体液因子过度激活的药物。     

AAI与VVI起搏对血液动力学及心钠素、肾素─血管紧张素系统影响的研究

观察１２例心律失常病人不同频率（７０，９０及１１０ｐｐｍ）ＡＡＩ和ＶＶＩ起搏时的心排出量（ＣＯ）、心脏指数（ＣＩ）、肺毛细血管楔嵌压（ＰＣＷＰ）、肺动脉压（ＰＡＰ）、右房压（ＲＡＰ）和血浆心钠素（ＡＮＰ）、肾素活性（ＰＲＡ）及血管紧张素ＩＩ（Ａ－ＩＩ）的变化。结果显示：ＡＡＩ起搏时，ＣＯ、ＣＩ显著高于ＶＶＩ起博和较慢的自身窦性心律时（Ｐ＜０．０５或０．０１），而无ＶＶＩ起搏所引起的ＰＣＷＰ、ＰＡＰ、ＲＡＰ、ＡＮＰ、ＰＲＡ及Ａ－ＩＩ等显著增高缺点。提示ＡＡＩ起博具有良好的血液动力学效应且不导致心脏内分泌激素异常而优于ＶＶＩ。     

Clinical implications of increased plasma angiotensin II despite ACE inhibitor therapy in patients with congestive heart failure.

AIMS: The aim of the study was to assess the incidence and clinical implications of increased plasma angiotensin II despite chronic ACE inhibitor therapy in patients with heart failure. METHODS AND RESULTS: The studied population consisted of 70 patients (mean age 59+/-9 years). Plasma renin activity and plasma concentration of aldosterone, norepinephrine, atrial natriuretic peptide, angiotensin II, tumour necrosis factor, interleukin-6 and interleukin-1B were assessed at 6 months of ACE inhibitor therapy. Mean left ventricular ejection fraction was 24+/-5% and the end-systolic and end-diastolic diameters were 59+/-9 and 71+/-8 mm, respectively. Despite chronic enalapril or captopril therapy, 35 patients (50%) had increased plasma angiotensin II (median 33 pg. ml(-1), range 17-84), while it was in the normal range in the remaining 35 patients (median 10 pg. ml(-1), range 5-15). Plasma renin activity (P=0.005), interleukin-6 (P=0.004), New York Heart Association functional class III-IV (P=0. 006), furosemide dose (P=0.01), lack of beta-blocker therapy (P=0. 04) and norepinephrine (P=0.04) were univariately associated with increased angiotensin II. Multivariate regression analysis identified the plasma renin activity (0.0004), norepinephrine (0.02) and interleukin-6 (0.03) as independent predictors of plasma angiotensin II. During follow-up (35+/-29 months), nine (12.8%) patients died and 13 had new heart failure episodes. Increased plasma angiotensin II, despite ACE inhibitor therapy, was a significant predictor of death or heart failure according to the Kaplan-Meier survival method by log rank test (P=0.002). CONCLUSION: Fifty per cent of patients with heart failure, ha increased plasma angiotension II despite chronic ACE inhibitor therapy. These patients had higher neurohormonal activation and poor prognosis.     

国产米力农治疗严重心力衰竭患者的血液动力学和肾素—血管紧张素—醛固酮系统变化

本文报告国产米力农治疗15例严重心力衰竭患者的血液动力学变化及其对肾素—血管紧张素—醛固酮(RAA)系统的影响。结果表明,用药后心指数、每搏指数增加(P<0.01),平均动脉压、平均右房压、平均肺动脉压和肺毛细血管嵌压下降(P<0.05或0.01);血浆肾素活性无变化(P>0.05),血管紧张素Ⅱ和醛固酮降低(P<0.05)。这提示国产米力农可明显改善严重心衰患者的血液动力学紊乱和抑制RAA系统激活。     

螺内酯对扩张型心肌病心力衰竭患者某些体液因子的影响

目的 :探讨螺内酯对扩张型心肌病心力衰竭患者血浆儿茶酚胺、肾素活性、血管紧张素Ⅱ及醛固酮的影响。方法 :入选 2 0例扩张型心肌病心力衰竭患者 ,随机分入螺内酯组与对照组 ,各 10例 ,用螺内酯治疗前与治疗 1个月后 ,用高效液相色谱方法测定血浆去甲肾上腺素、肾上腺素 ,同时采用均相竞争放射免疫方法检测血浆肾素活性、血管紧张素 Ⅱ与醛固酮。结果 :治疗 1个月后螺内酯组血浆去甲肾上腺素、肾上腺素、肾素活性及醛固酮明显低于治疗前 ,也低于对照组。结论 :螺内酯可明显抑制扩张型心肌病心力衰竭患者的儿茶酚胺水平 ,降低肾素活性及醛固酮 ,这些改变有可能为螺内酯明显改善心力衰竭病人预后的重要机制     

Prognostic value of cytokines and neurohormones in severe heart failure

BACKGROUND AND OBJECTIVES: The screening of candidates for heart transplantation continues to present difficulties. High plasma levels of cytokines and neurohormones have been associated with a poor prognosis in heart failure but their usefulness for identifying candidates for heart transplantation is still not established. METHODS: In 83 patients (59 11 years old), with systolic left ventricular dysfunction and New York Heart Association functional class III-IV, we assessed levels of aldosterone, atrial natriuretic peptide, plasma renin activity, angiotensin II, norepinephrine, endothelin, interleukin-6 and tumor necrosis factor-alpha. RESULTS: Over the following year, 13 patients died and 26 received heart transplantation. Mean ejection fraction was 23 6%, end-diastolic and end-systolic diameters were 73 10 and 60 10 mm, respectively. Univariate analysis identified the following variables to be associated with poor prognosis: angiotensin II (p = 0.001), norepinephrine (p = 0.003), plasma renin activity (p = 0.02), systolic blood pressure (p = 0.006), end-diastolic diameter (p = 0.02) and end-systolic diameter (p = 0.04). Multivariate regression analysis identified the following variables to be independent predictors of death or need for heart transplantation: a low cardiac index (p = 0.007), plasma angiotensin II (p = 0.001) and pulmonary capillary wedge pressure (p = 0.04) The sensitivity and specificity of angiotensin II for predicting poor outcome was only moderate according to interpretation of the receiver operating curves. CONCLUSIONS: Although plasma angiotensin II was the best neurohormone for identifying patients with severe heart failure and the worst prognosis, its sensitivity and specificity for predicting death or the need for heart transplantation was limited. The decision to transplant should continue to be based on clinical and hemodynamic parameters.     

Plasma concentrations of alpha-human atrial natriuretic polypeptide and cyclic GMP in patients with heart disease

Plasma concentrations of immunoreactive alpha-human atrial natriuretic polypeptide (i alpha-hANP) and cyclic guanosine monophosphate (cGMP) were measured in 70 patients with heart disease. Plasma concentrations of i alpha-hANP were directly related to the severity of heart disease (F = 29.61, p less than 0.001). Plasma concentrations of i alpha-hANP were well correlated with pulmonary capillary wedge pressure (PCWP; r = 0.64, p less than 0.001), mean pulmonary arterial pressure (PAP; r = 0.62, p less than 0.001), and mean right atrial pressure (RAP; r = 0.75, p less than 0.001). Plasma concentrations of cGMP were also directly related to the severity of heart disease (F = 13.61, p less than 0.001) and highly correlated with plasma concentrations of i alpha-hANP (r = 0.73, p less than 0.001). Plasma concentrations of cGMP were also closely correlated with PCWP (r = 0.69, p less than 0.001), mean PAP (r = 0.61, p less than 0.001), and mean RAP (r = 0.60, p less than 0.001). The i alpha-hANP concentrations of plasma samples obtained from the coronary sinus were approximately fourfold higher than those of samples obtained from the pulmonary artery, whereas cGMP concentrations were comparable in plasma samples obtained from either site. Elevation of cGMP concentrations following intravenous infusion of synthetic alpha-hANP was comparable in plasma samples obtained from the coronary sinus and the pulmonary artery. These findings suggest that elevated plasma concentrations of i alpha-hANP in cardiac patients result from an increase in the secretion of ANPs, which is probably accelerated by elevation of right or left atrial pressure, and that plasma concentrations of cGMP reflect circulating levels of alpha-hANP.     

Effects of adding spironolactone to an angiotensin-converting enzyme inhibitor in chronic congestive heart failure secondary to coronary artery disease

In chronic heart failure, a diuretic plus an angiotensin-converting enzyme (ACE) inhibitor only partially suppresses aldosterone despite the fact that aldosterone has many harmful effects independent of angiotensin II. These possible harmful effects of aldosterone are magnesium loss, increased cardiac sympathetic activity, and increased ventricular arrhythmias. We have therefore assessed whether adding the aldosterone antagonist, spironolactone, to a loop diuretic and ACE inhibitor reverses any of these potentially harmful effects of residual aldosterone. In a preliminary animal study, we found that exogenous aldosterone reduced myocardial norepinephrine uptake by 24% in anesthetized rats in vivo. In our main study, 42 patients with New York Heart Association II to III congestive heart failure were randomized to spironolactone (50 to 100 mg/ day, titrated to blood pressure and plasma potassium) or placebo in a double-blind fashion. Our principal finding is that cardiac norepinephrine uptake as assessed by ¹²³I-metaiodobenzylguanidine scintigraphy increased with spironolactone (p < 0.01). Spironolactone also elevated plasma magnesium (p < 0.05), reduced urinary magnesium excretion (p < 0.05), and caused a reduction in ventricular arrhythmias on 24-hour ambulatory electrocardiography (p < 0.05). Spironolactone increased plasma renin activity, plasma aldosterone (p < 0.01), 24-hour urinary sodium excretion (p < 0.05), and urinary sodium/potassium ratio (p < 0.01). Echocardiographic-determined measurements of left ventricular systolic and diastolic function were unaltered by spironolactone. Therefore, spironolactone has potentially beneficial effects on cardiac adrenergic tone, divalent cation balance, and ventricular arrhythmias in patients with chronic heart failure who are already receiving standard doses of ACE inhibitors. All of these factors could be significant in the prevention of sudden cardiac death in this population.     

重组人脑利钠肽治疗急性心力衰竭患者的临床观察

目的:观察重组人脑利钠肽(recombinant human brain natriuretic peptide,rhBNP)治疗急性心力衰竭(acute heart failure,AHF)患者的临床疗效、血流动力学效应及药物安全性。方法:入选住院的102例AHF患者,随机分为rhBNP治疗组和硝普钠(NIP)对照组。2组在常规抗心衰治疗的基础上,rhBNP组加用新活素,NIP组加用硝普钠,持续静脉滴注24 h。分组后再于rhBNP组中选取15例(G1组),NIP组中选取16例(G2组),应用Swan-Ganz导管行血流动力学监测,比较患者用药前后临床症状、心功能及血流动力学参数的变化。结果:1.治疗24 h后患者呼吸困难均减轻,rhBNP组好转程度优于NIP组(P<0.05)。2.rhBNP组和NIP组肺部湿啰音均有改善,rhBNP组改善更明显(P<0.05)。3.2组心率(HR)均明显下降(P<0.05),但组间比较差异无统计学意义。4.治疗后rhBNP组尿量较NIT组有增多趋势,差异无统计学意义(P>0.05)。5.患者左心室射血分数(LVEF)均有提高(P<0.05),rhBNP组升高更明显(P<0.05);但2组治疗前后左心室舒张末期内径(LVDD)无明显变化(P>0.05)。6.2组PCWP、PAP均降低,G1组明显优于G2组(P<0.01),在用药后30 min 2组差异有统计学意义(P<0.05)。7.rhBNP组的不良事件主要是低血压,但与NIP组相比差异无统计学意义(P>0.05)。结论:rhBNP治疗急性AHF患者疗效显著,短期效果优于常规硝普钠治疗,且临床应用中安全可行。