重组人脑利钠肽治疗老年难治性心力衰竭的近期疗效

目的：观察重组人脑利钠肽（rhBNP）治疗老年难治性心力衰竭的近期疗效。方法：106例老年难治性心力衰竭患者,随机分为两组。两组均接受规范的抗心力衰竭基础治疗（其中rhBNP组不使用常规利尿药）。rhBNP组（n=52）加用rhBNP,首先给予1.5μg/kg静脉负荷量,然后以0.0075～0.01μg（/kg·min）静脉微泵注射,维持72h;对照组（n=54）静脉泵入硝普钠,起始剂量10μg/min,观察治疗反应,每5～10min增加1次,每次增加5μg/min,直至达到临床效应,输注72h。记录两组治疗前、后的心率、血压、24h尿量、左室射血分数（LVEF）、N-末端脑利钠肽原（NT-proBNP）及治疗后的全身临床情况。结果：两组患者治疗后临床症状、体征及心率、24h尿量、LVEF、NT-proBNP均较治疗前显著改善（P〈0.05或P〈0.01）,rhBNP组优于对照组（P〈0.01）。rhBNP组的显效率（55.77%）及总有效率（94.23%）明显高于对照组（35.19%、79.63%）（P〈0.01）。rhBNP组的NT-proBNP水平降低,LVEF值提高,24h尿量增加,心率减慢和全身临床状况改善,尤其以呼吸困难缓解的程度均较对照组显著（P〈0.01）。两组在治疗期间未见明显不良反应发生。结论：应用rhBNP治疗老年难治性心力衰竭近期疗效好,且安全、可行。

Short-term Efficacy of Recombinant Human Brain Natriuretic Peptide in the Treatment of Elderly Refrac- tory Heart Failure

OBJECTIVE： To observe the short-term efficacy of recombinant human brain natriuretie peptide （rhBNP） on elderly refractory heart failure （RHF）. METHODS： 106 elderly patients with RHF were randomly divided into 2 groups. 2 groups were given conventional treatment of anti-heart failure （common diuretic was not used in rhBNP group）. 52 cases in rhBNP group were additionally given rhBNP with initial dose of 1.5 pg/kg, and then given intravenous minipump injection of 0.007 5-0.01 g/（kg min） for 72 h; 54 cases in control group were given sodium nitroprusside with initial dose of 10 g/min, increasing by 5 g/min each interval of 5-10 mins for 72 h until therapeutic effect was obtained. Heart rate, blood pressure, 24 h urine, LVEF and NT-proBNP were recorded in 2 groups before and after treatment, and systemic condition was evaluated after treatment. RESULTS： Clinical symptom, sign, heart rate, 24 h urine, LVEF, NT-proBNP of 2 groups were improved significantly after treatment （P〈 0.05 or P〈0.01）. Those index of rhBNP was better than those of control group （P〈0.01）. Effectual rate （55.77%） and total effective rate （94.23%） of rhBNP group were significantly higher than those of control group （35.19%, 79.63% ） （P〈0.01）. The levels of NT-proBNP and heart rate were decreased, and LVEF and 24 h urine volume were increased and systemic symptom was improved in rhBNP group, especially dyspnea relief of rhBNP group was better than that of control group （P〈0.01）. No adverse drug reaction was found in 2 groups during treatment. CONCLUSIONS： rhBNP shows good short-term clinical efficiency, and it is feasible and safe for elderly patients with refractory heart failure.