基因重组人脑钠肽对心脏手术后心力衰竭的疗效：104例患者的临床观察

目的观察心脏手术后心衰患者在抗心衰药物包括正性肌力药物，利尿药，磷酸二酯酶抑制剂等，基础上加用基因重组人脑钠肽的疗效。方法104例心脏手术后的心衰患者，男58例，女46例，年龄1～83岁，肾功能正常患者79例，肾功能不全患者25例，经常规抗心衰治疗，效果不明显。给予静脉微量泵推注重组人脑钠肽0．01μg（ks·min），平均维持35h。初步疗效观察指标为肺小动脉楔压（PAwP），终点疗效指标评价为平均肺动脉压（MPAP），心脏指数（CI），平均动脉压（MAP）血清肌酐浓度（SCr）和症状性低血压发生率。结果在常规抗心衰治疗基础上加用脑纳肽后PAWP降低35．2％（P〈0．01），MPAP降低14．6％，CI增加14．1％，MAP下降8．7％，SCr无明显变化。观察期间呼吸困难全部获得缓解，尿量明显增加，成人和儿童的临床疗效观察无明显差别。结论心脏手术后严重心衰患者在常规抗心衰治疗和正性肌力药基础上加用重组人脑纳肽，可显著改善血流动力学指标和临床症状体征。

Effects of recombinant human brain natriuretic peptide on heart failure after cardiothoracic surgery: observation of 104 patients

Objective To study the effects of recombinant human brain natriuretic peptide （rhBNP）on heart failure after cardiothoracic surgery. Methods One hundred and four patients 58 males and 46 females, aged 1-83, 25 patients with renal dysfunction, suffered from heart failure after cardiothoracic surgery and failed to show significant improvements after conventional treatment with routine anti-heart failure drugs, including positive inotropic drugs. Then rhBNP at the dose of 0.01μg/（kg·min） was perfused intravenously for 35 hours. The clinical manifestations, relevant hemodynamic indicators, such as pulmonary capillary wedge pressure （PCWP）, mean pulmonary arterial pressure （MPAP）, cardiac index （CI）, and mean arterial pressure （MAP）, and serum creatinine, （Scr） and urine volume were observed. Results During the rhBNP treatment, the symptom of dyspnoea was relieved in all patients. After the rhBNP treatment, the PCWPdecreased by 35.2%, MPAP decreased by 14.6%, CI increased by 14.1%, and MAP decreased by 8.7%. The urine output significantly increased, however, there was no significant change in the Scr. Conclusion rhBNP treatment in addition to conventional anti-heart failure treatment significantly improves the hemodynamic indicators and clinic appearance in patients with heart failure after cardiothoracic surgery.