新活素治疗急性心力衰竭患者临床研究

目的：探讨新活素（rhBNP）治疗内科危重症合并心力衰竭患者的临床疗效及安全性。方法选择我院重症内科2013年1~8月应用新活素辅助治疗的20例急性心力衰竭患者,观察患者治疗前及治疗后72h和7d的心率、呼吸频率、血压、24h尿量、肝肾功能、血浆氨基末端脑钠肽前体（NT-proBNP）变化。结果19例患者心功能明显改善,总有效率95%,新活素治疗后半小时患者呼吸频率、心率即有明显改善（P〈0.05）,72h及7d后呼吸频率、心率持续改善（P〈0.05）；新活素治疗3 d后患者尿量明显增加（P〈0.05）,7d后尿量不再增加,但部分患者应用利尿剂剂量明显减少；新活素治疗后半小时患者血压下降,但72h及7d后血压可恢复（P〉0.05）；新活素治疗后72h NT-proBNP即有明显下降（P〈0.05）,7d后下降更为明显,新活素治疗前后患者血清肌酐、尿素氮及谷丙转氨酶无明显变化（P〉0.05）。治疗过程中可出现一过性低血压和心律失常,但发生率低。结论新活素对急性心力衰竭的短期疗效显著,对肝肾功能无明显影响。

Clinical study of rhBNP in the treatment of patients with acute heart fail-ure

Objective To explore the clinical effect and safety of rhBNP in the treatment of patients with critical illness complicated with heart failure. Methods Twenty patients with acute heart failure who were given rhBNP as an assisted treatment from the department of critical care medicine in our hospital from January to August 2013 were selected. Changes of heart rate,respiratory rate,blood pressure,24-hour urine volume,hepatic and renal functions,NT-proB-NP in the patients before the treatment, 72 hours and 7 days after the treatment were observed. Results 19 patients showed obvious improvement of heart function, with the total effective rate of 95%. Patients＇respiratory rate and heart rate 30 minutes after the treatment showed significant improvement（P〈0.05）,and the improvement continued 72 hours and 7 days after the treatment （P〈0.05）; urine volume increased significantly 3 days after the treatment with rhBNP（P〈0.05）. The volume remained stable after 7 days, but some patients significantly reduced their dosage of diuretics;blood pressure decreased 30 minutes after the treatment, and it recovered to normal level after 72 hours and 7 days（P〉0.05）;NT-proBNP reduced obviously 72 hours after the treatment（P〈0.05）,and the reduction became significant after 7 days. There were no significant changes in patients＇ serum creatinine, urea nitrogen and glutamic-pyruvic transaminase （P〉0.05）. Transient low blood pressure and arrhythmia could be detected in the treatment, but the inci-dence was low. Conclusion RhBNP has favorable effect on acute heart failure in a short period without any significant negative effect on hepatic and renal functions.