脑利钠肽治疗急性失代偿性心力衰竭的疗效观察

目的探讨重组人脑利钠肽（rhBNP）治疗顽固性急性失代偿性心力衰竭的疗效及安全性。方法选取心功能为NYHAⅢ、Ⅳ级，经常规洋地黄强心和利尿剂利尿效果欠佳的顽固性的急性失代偿性心力衰竭患者86例，分为4组：重组人脑利钠肽（rhBNP）组24例，米力农组20例，硝酸甘油组22例，对照组20例。观察4组患者呼吸困难、肺部哆音、NYHA心功能分级，每分钟心搏出量（CO）、左室射血分数（LVEF）、肺小动脉楔压（PCWP）、中心静脉压（CVP），并观察肝肾功能。结果rhBNP组患者呼吸困难、肺部哆音、NYHA心功能分级改善以及CO增加[（2．5±1．6）L／min]、LVEF增加（22±8）％、PCWP减少[（20．5±8．1）mmHg]及CVP减少[（12．6±6．3）mmHg]均明显优于米力农组、硝酸甘油组和对照组（P〈0．05～0．01）；米力农组和硝酸甘油组明显优于对照组（P〈0．05）。米力农组和硝酸甘油组无显著性差异（P〉0．05）；4组肝肾功能均无显著变化。结论rhBNP治疗顽固性急性失代偿性心力衰竭疗效显著且安全性好。

Effect of Brain Natriuretic Peptide for Acute Decompensated Congestive Heart Failure

Objective To evaluate the effect and safety of recombinant human brain natriuretic peptide（rhBNP） for acute refractory decompensated congestive heart failure （ARDCHF）. Methods 86 cases of ARDCHF with grade NYHA Ⅲ to Ⅳ heart function and poor curative effect by routine digitalis and diuretic were selected and divided into 4 groups randomly ： rhBNP group （ n = 24 ） , Milrinone group （ n = 20 ） , Nitroglycerin group （ n = 22 ） and Control group （ n = 20 ）. The improvement of dyspnea, pulmonary moist rale and heart function in 4 groups were observed. Increase of cardiac output（CO） and left ventricular ejection fraction （LVEF） , reduce of pulmonary capillary wedge pressure （PCWP） and centre venous pressure （CVP） were studied. The hepatic and kidney function were evaluated. Results The improvement of dyspnea, pulmonary moist rale, heart function NYHA, increase of CO（2.5 ± 1.6） L/min,LVEF（22±8） % and reduce of PCWP（20.5 ±8.1 ） mm Hg,CVP（ 12.6 ±6.3） mm Hg in rhBNP groups were much higher than those of milrinone, nitroglycerin and control group（ P 〈0.05 to 0.01 ）. Those value of milrinone and nitroglycerin group were much higher than those of control group（ P 〈 0.05 ）. There was no difference between milrinone group and nitroglycerin group （ P 〉 0.05 ）. The hepatic and kidney function were all normal in 4 groups. Conclusion rhBNP is efficient and safe for ARDCHF.