重组人脑利钠肽治疗急性心力衰竭患者的临床观察

目的:观察重组人脑利钠肽(recombinant human brain natriuretic peptide,rhBNP)治疗急性心力衰竭(acute heart failure,AHF)患者的临床疗效、血流动力学效应及药物安全性。方法:入选住院的102例AHF患者,随机分为rhBNP治疗组和硝普钠(NIP)对照组。2组在常规抗心衰治疗的基础上,rhBNP组加用新活素,NIP组加用硝普钠,持续静脉滴注24 h。分组后再于rhBNP组中选取15例(G1组),NIP组中选取16例(G2组),应用Swan-Ganz导管行血流动力学监测,比较患者用药前后临床症状、心功能及血流动力学参数的变化。结果:1.治疗24 h后患者呼吸困难均减轻,rhBNP组好转程度优于NIP组(P<0.05)。2.rhBNP组和NIP组肺部湿啰音均有改善,rhBNP组改善更明显(P<0.05)。3.2组心率(HR)均明显下降(P<0.05),但组间比较差异无统计学意义。4.治疗后rhBNP组尿量较NIT组有增多趋势,差异无统计学意义(P>0.05)。5.患者左心室射血分数(LVEF)均有提高(P<0.05),rhBNP组升高更明显(P<0.05);但2组治疗前后左心室舒张末期内径(LVDD)无明显变化(P>0.05)。6.2组PCWP、PAP均降低,G1组明显优于G2组(P<0.01),在用药后30 min 2组差异有统计学意义(P<0.05)。7.rhBNP组的不良事件主要是低血压,但与NIP组相比差异无统计学意义(P>0.05)。结论:rhBNP治疗急性AHF患者疗效显著,短期效果优于常规硝普钠治疗,且临床应用中安全可行。

A clinical study of recombinant human brain natriuretic peptide on patients with acute heart failure

Objective:To observe the efficacy and safety of intravenous infusion recombinant human brain natriuretic peptide(rhBNP) on patients with acute heart failure.Methods:A total of 102 patients who suffered from acute heart failure patients ofⅢ～ⅣNew York Heart Association(NYHA)functional classifica-tion were randomized into rhBNP group(n=50)and NIP group(n=52)),The rhBNP group received rhB-NP,The NIP group was used with lasting vein pump of sodium nitroprusside afollowed for 24 hrs.,all the pa-tients were treated with traditional heart failure treatment.Then,depending on the use of Swan-Ganz,the patientswere allocated to catheter group(G1 group,n=15)and noncatheter group(G2 group,n=16).Observed thechange of the symptoms of physical condition and the hemodynamic parameters.Results:1.Dyspnea improve-ments were more significant in rhBNP group compared to NIP group(P<0.05).2.the severity of pulmonaryralements were improved in rhBNP group compared with NIP group(P<0.05).3.HR were decreased obvi-ously after rhBNP or NIP infusion(P<0.05),and no significant difference between them(P>0.05).4.Thetotal urine output in rhBNP group tended to behigher than that in NIP group(P>0.05).5.Both LVEF wereincreased,and the rhBNP group was better(P<0.05).LVDD remained almost unchanged during the treat-ment of rhBNP and NIP(P>0.05).6.PCWP and PAP were both decreased,and there was more significantreduction between 30 min in rhBNP group.7.the blood pressure of both were decreased(P<0.05),MACEwas also similar between the two groups.Conclusion:Intravenous injection of rhBNP is efficient and safe for a-cute heart failure patients.it is also feasible and safe for clinic use in AHF patients.