重组人脑钠肽对心肌梗死所致急性心力衰竭的血流动力学和肾功能的影响

目的 探讨重组人脑钠肽对心肌梗死所致急性心力衰竭的疗效和肾功能的影响.方法 采用自身对照研究方法,对入选的50例心肌梗死所致急性心力衰竭患者,在常规治疗基础上,静脉注射重组人脑钠肽2 μg/kg冲击治疗,随后给予0.01 μg/（kg·min）持续静脉泵入24～48 h,使用Swan-Ganz导管监测患者用药前及用药30 min、3h、12h、24h、48 h后血流动力学的变化,并观察患者呼吸困难改善程度,检测血浆脑钠肽、尿素氮、血肌酐浓度和24 h尿量.结果 所有患者均完成了48 h的治疗,治疗24 h和48 h后患者呼吸困难症状得到明显改善,改善率分别为82.0％和90.0％.患者肺毛细血管楔压、中心静脉压、肺动脉收缩压及心率均明显下降,心排血量指数明显增加,治疗后各时间点与治疗前比较均差异有统计学意义（P均＜0.05）;治疗后24 h尿量增加,血浆脑钠肽浓度降低,与治疗前比较差异有统计学意义（P＜0.05）;治疗后患者尿素氮和血肌酐浓度轻度增加,血钾轻度降低,但与治疗前比较差异无统计学意义（P＞0.05）,停药后病情未见进一步加剧.结论 重组人脑钠肽可改善急性心力衰竭患者心功能,改善呼吸困难症状,有效防止水钠潴留,且患者具有较好耐受性.

Influence of recombinant human brain sodium peptide on hemodynamics and renal function in treating acute heart failure induced by myocardial infarction

Objectlves To investigate the influence of recombinant human brain sodium peptide on hemodynamics and renal function in treating acute heart failure induced by myocardial infarction. Methods Fifty patients with acute heart failure caused by myocardial infarction received conventional treatment and shock therapy with recombinant human brain peptide（2 txg/kg）. Then they were continuously given intravenous pumping of recombinant human brain peptide 0.01 μg/（kg-min） for 24-48 h. Changes of hemodynamics and breathing difficulty before treatment and 30 rain, 3 h, 12 h, 24 h, 48 h after treatment were monitored by Swan-Ganz catheter. Plasma brain natriuretic peptide, urea nitrogen, serum creatinine and 24 h urine output were also observed. Results All patients completed the 48 h treatment. Improved rates of dyspnea symptoms were 82.0% and 90.0% after 24 h and 48 h treatment respectively. Pulmonary capillary wedge pressure, central venous pressure, pulmonary artery systolic blood pressure, heart rate and plasma concentrations of brain natriuretic peptide of the patients at every time point after treatment were significantly lower than those before treatment（P〈0.05）, while cardiac blood index and 24 hour urine volume significantly increased （P〈0.05）. Concentrations of urea nitrogen and serum creatinine after treatment slightly increased and potassium slightly reduced, but there were no statistical differences compared with those before treatment （P〉0.05）. No worse conditions were shown after drug withdrawal. Conclusions Recombinant human brain peptide can improve cardiac function in patients with acute heart failure, improve the symptoms of dyspnea, effectively prevent water and sodium retention, and patients are with good tolerance of it.