硝普钠与乌拉地尔对难治性心力衰竭患者B型脑钠肽的影响

目的观察乌拉地尔对难治性心力衰竭（CHF）患者BNP的影响。方法选择我院难治性心力衰竭患者60例，随机分为治疗组和对照组各30例，入院后常规给予吸氧、镇静、强心、利尿剂等治疗，并根据血压、心率等情况加用血管紧张素转换酶抑制剂、β-受体阻滞剂，并给予病因治疗，抗感染控制血糖血脂，纠正电解质紊乱等治疗。治疗组给予乌拉地尔起始剂量4—6μg·kg^-1·min^-1泵入，以后根据血压及病情调整剂量。对照组患者给予硝普钠，起始剂量0．5μg·kg^-1·min^-1，同样根据血压等情况逐渐加量，不超过10μg·kg^-1·min^-1，两组均持续静点2～3d。治疗前、后测定BNP、心功能分级及左心室射血分数（LVEF）。结果两组患者临床疗效间差异有显著性意义（P〈0．05）。两组患者治疗前、后BNP、LVEF间差并均有显著性意义（P〈0．05）；两组患者治疗后BNP间差异亦有显著性意义（P〈0．05）。对照组有6例出现不同程度的头晕、恶心呕吐、头疼等症状；治疗组有4例出现头晕、恶心，均经对症处理后好转，血、尿常规及肝、肾功能未见异常改变。结论在综合治疗基础上应用乌拉地尔治疗可以更明显的改善心功能，BNP检测既可反映CHF的严重程度，在反映药物疗效方面也有临床参考价值。

Clinical Study of Blood B-type Natriuretic Peptide Level and Effects between Nipruton and Urapidil for Treatment of the Stubborn Congestive Heart Failure

Objective To evaluate the value of BNP in prognosis of patients with congestive heart failure by treating with Niprnton and Urapidi. Methods After treated by routine measure, 60 CHF patients accepted treatment with Nipruton and Urapidil. Blood BNP and LVEF were measured before treat and after treat. Results The total efficient rate in Urapidil group is more higher than Nipruton group （ P 〈 0. 05）. The index of heart function such as LVEF and BNP can improve in both groups after the therapy （ P 〈 0. 05 ）, but Blood BNP concentration of two group changed more than LVEF （ P 〈 0. 05）. Conclusion Urapidil can be more efficient in treating stubborn congestive heart failure than Nipruton and have no more side effects The change of blood BNP level after treatment can reflect treatment - responsiveness in heart failure patients.