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。

Efficacy study of recombinant human brain natriuretic peptide in patients with acute decompensated heart failure and different severities of H2O/Na+ retention

AIM: To compare the effect of intravenous infusion of recombinant human brain natriuretic peptide (rhBNP) on the hemodynamic profile and its clinical efficacy in patients with acute decompensated heart failure (ADHF). METHODS: Forty ADHF patients enrolled in our hospital were randomized equally to catheter group where hemodynamic changes were monitored with Swan-Ganz and noncatheter group (n=20 in each group). Pulmonary capillary wedge pressure (PCWP), pulmonary artery pressure (PAP) and right atrial pressure (RAP) were recorded and cardiac output (CO) and cardiac index (CI) were assessed by heat-sensitive dilution method before drug administration and 0.5, 1, 3, 6 and 24 h after drug administration. Patients were divided into experiment group and control group and all patients received rhBNP with an initial i.v. bolus of 2 μg/kg followed by continuous i.v. titration of 0.01 μg/(kg·min) for 24 h. Dyspnea, overall symptom improvement in clinical conditions and fluid input and output were recorded before and 0.5, 1, 3, 6 and 24 h after drug administration. RESULTS: The alleviation of dyspnea and overall symptoms were more significant in experimental group compared to those in control group, accompanied by enhanced natriuretic effect ［(2.7±0.8) L vs.(1.7±0.4) L, P=0.01］. Patients in the experiment group experienced more rapid, apparent, stable and long-lasting declines in PCWP and RAP, with significant difference between groups. No significant intergroup difference was found in PAP between groups and no inter- and intra-group significant differences were observed in CI. CONCLUSION: Compared with ADHF patients with less severe H2O/Na+ retention, ADHF patients with more serious H2O/Na+ retention have more favorable acute hemodynamic profile and better clinical response to rhBNP treatment. ADHF patients with severe H2O/Na+ retention may be the optimal target population for clinical application of rhBNP treatment.