重组人脑利钠肽治疗顽固性心力衰竭临床研究

目的 研究重组人脑利钠肽(rhBNP)治疗顽固性心力衰竭(RHF)患者血液动力学效应及安全性.方法 选择住院期间经常规抗心力衰竭药物强化治疗无明显改善的RHF患者16例,给予rhBNP 1.5 μg/kg静脉冲击后,以0.007 5μg/(kg·min)连续静脉滴注24h.在给药后24h内监测有创血液动力学参数、血压、心率及血清生化指标,应用rhBND 3 d后,行超声心动图检测心脏指数(CI)、左心室舒张末期容积(LEVDD)、左心室射血分数(LVEF).结果 在注射rhBNP 15 min时肺毛细血管楔压PCWP(22.7±4.0)mm Hg与(25.3±3.9)mm Hg]、平均肺动脉压MPAP(31.9±3.6)mm Hg与(34.6±7.8)mm Hg]较基础值明显下降(P＜0.05);收缩压在给药后1h下降(105.2±11.5)mm Hg与(119.0±17.2)mm Hg],差异有统计学意义(P均＜0.01),以后逐渐恢复至基线时水平;用药24h心率也明显改善(109.0±10.8)次/min与(82.2±8.6)次/min](P ＜0.01);血钾、血钠、血肌酐无明显变化;用药3d后CI(3.7±0.6)L/m2与(1.8±0.4)L/m2]和EF(43.1±8.3)％与(31.2±6.4)％]均有明显改善,LVEDD明显缩小(63.6±5.7)mm与(67.3±6.2)mm](P均＜0.01).未发生与rhBNP相关的症状性低血压及其他严重不良反应.结论 静脉应用rhBNP能迅速改善RHF患者血液动力学状况,且安全可行.

Efficacy of recombinant human brain natriuretic peptide in refractory heart failure

Objective To study the effect and safety of recombinant human brain natriuretic peptide (rhBNP)on hemodynamics in patients with refractory heart failure(RHF).Methods A total of 16 patients with RHF were enrolled in the study.We defined RHF as the symptoms and signs had not been improved with conventional intensive treatment.The patients started to receive the infusion of rhBNP with 1.5 μg/kg bolus intravenous injection followed by 0.007 5 μ4/(kg · min)for 24 hours.During 24 hours,the hemodynamic parameters,systolic blood pressure,heart rate and electrolyte were monitored.After rhBNP infused,echocardiography was used to measure the cardiac index(CI),left ventricular end diastolic diameter(LEVDD)and ejection fraction(EF)in the third day.Results After rhBNP infused,pulmonary capillary wedge pressure (PCWP),mean pulmonary artery pressure(MPAP)were significantly reduced at 15 minutes(PCWP22.7 ±4.0]mm Hg vs25.3 ±3.9]mm Hg;MPAP31.9 ±3.6]mm Hg vs34.6 ±7.8]mm Hg,P ＜0.05),the systolic blood pressure decreased remarkably at one hour(105.2 ± 11.5]mm Hg vs119.0 ± 17.2]mm Hg,P ＜ 0.01),and the effect disappeared gradually,heart rate decreased remarkably(109.0 + 10.8]beat/min vs 82.2 ± 8.6]beat/min).blood K +,Na + and renal function remained unchanged(P ＞ 0.05).CI(3.7 ± 0.6]L/m2 vs1.8 ±0.4]L/m2),LEVDD(63.6 ±5.7]mm vs67.3 ±6.2]mm)and EF(43.1 ±8.3]％ vs 31.2 ± 6.4]％)were significantly improved(P ＜ 0.01).There was no symptomatic hypotension or other adverse events.Conclusion Injection of rhBNP is safe,feasible,and effective in patients with refractory heat failure for improving hemodynamics.