重组人脑利钠肽治疗急性心梗后失代偿性心力衰竭的疗效观察

目的:观察重组人脑利钠肽(rhBNP)治疗急性心肌梗死后失代偿性心力衰竭的临床疗效和安全性.方法:选择急性心肌梗死合并失代偿性心力衰竭、心功能Killip Ⅲ级的患者63例,随机分为rhBNP组(32例)和多巴酚丁胺组(31例),在标准抗缺血治疗和静脉用呋塞米针剂抗心衰治疗的基础上,分别加用rhBNP(1.5 μg·kg-1静脉推注后,以0.007 5～0.01 μg·kg-1·min-1,静脉微泵注射72 h)和多巴酚丁胺(2.5～10 μg·kg-1·min-1,静脉微泵注射72 h).在用药前及用药72 h后测定两组患者血脑钠肽(BNP)、左室射血分数(EF)值,重新评价患者心功能Killip分级,观察患者72 h治疗过程中利尿剂用量及血压的变化,并观察30 d内的病死率.结果:两组血BNP均下降,rhBNP组更加明显(P<0.01);与多巴酚丁胺组比较,rhBNP组EF及心功能Killip分级均改善(P<0.01),利尿剂用量减少(P<0.01);两组患者30 d病死率无明显差异(P>0.05).结论:与多巴酚丁胺比较,rhBNP能更好地改善急性心肌梗死后失代偿性心力衰竭患者的临床症状,但对预后的改善未见明显差异.

Efficacy of recombinant human B-type natriuretic peptide on acute heart failure caused by acute myocardial infarction

Objective: To investigate the efficacy and safety of recombinant human B-type natriuretic peptide(rhBNP) on acute heart failure resulted from acute myocardial infarcfion.Methods: Sixty-three patients with cardiac function KillipⅢ were randomly divided into rhBNP group(n=32) and dobutamine group(n=31).All patients received standard anti-ischemic treatment and anti-heart failure treatment by intravenous injection of furosemide only.rhBNP group was given rhBNP 1.5 μg·kg-1 bolus injection intravenously,then 0.007 5～0.01 μg·kg-1·min-1 for 72 hours.Dobutamine group was given dobutamine 2.5～10 μg·kg-1·min-1for 72 hours.The blood BNP,left ventricular ejection fraction(EF%) were determined before treatment and after 72 hours treatment,cardiac function of the patients were re-evaluation by Killip classification.The amount of diuretics,blood pressure,and 30 days mortality were observed.Results: Compared with dobutamine group,blood BNP was significantly decreased in the rhBNP group(P<0.01),EF and Killip classification of cardiac function improved significantly(all P<0.01),the amount of diuretics was reduced(P<0.01).No significant difference was found in 30-day mortality between the two groups(P>0.05).Conclusion: Compared with dobutamine,rhBNP is better in improve heart function of patients with acute decompensated heart failure resulted from acute myocardial infarction,but there is no difference in prognosis between them.