重组人脑利钠肽联合常规抗心力衰竭药物治疗急性失代偿性心力衰竭的临床观察

目的 观察重组人脑利钠肽(rhBNP)治疗急性失代偿性心力衰竭(ADHF)患者的临床疗效对血浆N端脑利钠肽(NT-proBNP)、血流动力学参数的影响.方法 112例住院ADHF患者,完全随机分成对照组和rhBNP组:对照组54例,予以常规抗心力衰竭治疗;rhBNP组58例,在常规抗心力衰竭治疗基础上加用新活素(冻干rhBNP)静脉注射治疗.留置Swan-Ganz导管监测患者血流动力学参数,比较2组患者治疗前后临床症状、血浆NT-proBNP、肺毛细血管楔压(PCWP)、肺动脉压力(PAP)、右心房压力(RAP)及肝、肾功能的差异.结果 2组患者呼吸困难均有所改善,rhBNP组与对照组改善率分别为96.6%(56/58)、88.9%(48/54),rhBNP组优于对照组(P<0.05);心功能亦有所改善,rhBNP组优于对照组(P<0.05).rhBNP组NT-proBNP呈先升高后降低变化:治疗24 h时NT-proBNP明显升高(P<0.05),停药后2 d NT-proBNP值明显降低(P<0.05),rhBNP组优于对照组(P<0.05).2组患者血流动力学参数(PCWP、PAP、RAP)均降低,rhBNP组于治疗30 min时较基线PCWP值降低30.3%;PAP于治疗1 h时降低33.85%;rhBNP组下降更明显(P<0.05).rhBNP组发生低血压7例(12.1%),对照组发生低血压5例(9.3%),2组差异无统计学意义(P>0.05).结论 联合应用rhBNP明显改善ADHF患者临床症状,明显降低NT-proBNP水平、改善血流动力学参数,优于常规抗心力衰竭治疗.rhBNP是治疗ADHF安全有效的药物.

Abstract：

Objective To observe the efficacy and safety of intravenous infusion recombinant human brain natriuretic peptide(rhBNP)in patients with acute decompensated heart failure.Methods A total of 112 patients who suffered from acute decompensated heart failure patients were randomized into rhBNP group and control group.The rhBNP group received continuous intravenous infusion of rhBNP for 48 hours.All the patients were treated with concomitant medical therapy in accordance to AHA/ACC heart failure guidelines.Observed the change of the symptoms of physical condition and the hemodynamic parameters were observed.Results Dyspnea improvements were more significant in rhBNP group than in control group(P<0.05).Initially the NT-proBNP values increased but started to decrease in rhBNP group 2 days after withdrawal:24 h after treatment the NT-proBNP values significantly increased(P<0.05),whereas 2 hours after withdrawal of rhBNP,the NT-proBNP values decreased in the rhBNP group.And the NT-proBNP values in the control group were significantly higher than in rhBNP group(P<0.05).Pulmonary capillary wedge pressure(PCWP),right atrial pressure(RAP)and pulmonary artery pressure(PAP)de-creased in both rhBNP group and control group,and the NT-proBNP values in rhBNP group decreased to a larger extent as compared to the control group(P<0.05).seven patients in rhBNP group had hypotension.Conclusion In-travenous injection of rhBNP can significantly reduce the NT-proBNP level and improve hemodynamic parameters and clinical symptoms.

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

Objective To observe the efficacy and safety of intravenous infusion recombinant human brain natriuretic peptide(rhBNP)in patients with acute decompensated heart failure.Methods A total of 112 patients who suffered from acute decompensated heart failure patients were randomized into rhBNP group and control group.The rhBNP group received continuous intravenous infusion of rhBNP for 48 hours.All the patients were treated with concomitant medical therapy in accordance to AHA/ACC heart failure guidelines.Observed the change of the symptoms of physical condition and the hemodynamic parameters were observed.Results Dyspnea improvements were more significant in rhBNP group than in control group(P<0.05).Initially the NT-proBNP values increased but started to decrease in rhBNP group 2 days after withdrawal:24 h after treatment the NT-proBNP values significantly increased(P<0.05),whereas 2 hours after withdrawal of rhBNP,the NT-proBNP values decreased in the rhBNP group.And the NT-proBNP values in the control group were significantly higher than in rhBNP group(P<0.05).Pulmonary capillary wedge pressure(PCWP),right atrial pressure(RAP)and pulmonary artery pressure(PAP)de-creased in both rhBNP group and control group,and the NT-proBNP values in rhBNP group decreased to a larger extent as compared to the control group(P<0.05).seven patients in rhBNP group had hypotension.Conclusion In-travenous injection of rhBNP can significantly reduce the NT-proBNP level and improve hemodynamic parameters and clinical symptoms.