重组人脑利钠肽对重症心力衰竭患者血流动力学的干预研究

目的观察重组人脑利钠肽（rhBNP）对重症心力衰竭患者血流动力学的影响。 方法选择2016年2月至2019年3月入住上海市浦东医院综合ICU的急性心功能不全或慢性心功能不全急性加重期的52例重症心力衰竭患者，采用随机数字表法分成对照组和rhBNP组，每组各26例。其中，对照组和rhBNP组各有5例和4例因不符合病例研究标准被剔除本研究，最终对照组和rhBNP组分别纳入21例、22例。两组患者均给予包括治疗原发基础疾病、改善心功能的常规药物治疗及营养支持等一般治疗。对照组患者在一般治疗基础上使用硝酸异山梨酯，rhBNP组患者则在一般治疗基础上给予rhBNP，均连用5 d。记录两组患者入组时的一般资料，比较两组患者治疗前及治疗后1、3、7 d的全心射血分数（GEF）、心脏指数、全心舒张末容积指数（GEDI）、外周血管阻力指数（SVRI）、血管外肺水指数（ELWI）、平均动脉压和中心静脉压等血流动力学指标，氨基末端脑利钠肽前体（NT-proBNP）及24 h尿量。 结果两组患者治疗前与治疗后1、3、7 d的GEF、心脏指数、GEDI、SVRI、ELWI、平均动脉压、中心静脉压、NT-proBNP表达水平及24 h尿量比较，差异均有统计学意义（F = 20.864、8.982、89.286、102.485、43.824、12.562、10.189、123.848、89.264，P均<0.05）。进一步两两比较发现，rhBNP组治疗后3、7 d的GEF、心脏指数、GEDI、SVRI、ELWI、平均动脉压、中心静脉压及治疗后1、3、7 d的NT-proBNP表达水平和24 h尿量与对照组同时间点比较，差异均有统计学意义（P均<0.05）。rhBNP组患者中，治疗后3、7 d的GEF （20.6 ± 5.2）%、（28.7 ± 5.2）%、（12.2 ± 4.2）%]、心脏指数（2.88 ± 0.36）、（3.68 ± 0.42）、（2.02 ± 0.46）L·min^-1·m^-2]及治疗后1、3、7 d的24 h尿量（1 680 ± 220）、（1 868 ± 246）、（2 198 ± 228）、（1 568 ± 248）mL]均较同组治疗前显著升高，且治疗后7 d更高（P均< 0.05）；治疗后3、7 d的GEDI （947 ± 110）、（791 ± 110）、（1 108 ± 100）mL/m²]、SVRI （2 642 ± 508）、（2 218 ± 568）、（3 289 ± 510）dyn·sec·cm^-5·m²]、ELWI （9.3 ± 2.5）、（8.6 ± 2.1）、（12.3 ± 2.7）mL/kg]、平均动脉压（73 ± 6）、（69 ± 5）、（80 ± 6）mmHg]、中心静脉压（8.7 ± 1.4）、（7.1 ± 1.3）、（12.3 ± 2.1）mmHg]及治疗后1、3、7 d的NT-proBNP表达水平（4 829 ± 326）、（3 029 ± 298）、（2 006 ± 300）、（6 979 ± 469）ng/L]均较同组治疗前显著降低，且治疗后7 d更低（P均< 0.05）。 结论与硝酸异山梨酯相比，rhBNP更有助于改善重症心力衰竭患者的血流动力学，从而改善患者的心功能，值得在ICU中推广应用。

Effect of recombinant human brain natriuretic peptide on hemodynamics in patients with severe heart failure

ObjectiveTo observe the effect of recombinant human brain natriuretic peptide(rhBNP) on hemodynamics in patients with severe heart failure. MethodsTotally 52 patients with severe heart failure admitted to the General ICU of Shanghai Pudong Hospital between February 2016 and March 2019 were randomly divided into the control group (n = 26) and rhBNP group (n = 26). Five cases in the control group and 4 cases in the rhBNP group were excluded as they did not meet the standard of case study, so the final control group and rhBNP group respectively included 21 and 22 cases. Both groups were treated with routine drugs and nutritional support in order to treat their primary basic diseases and improve cardiac function. On this basis, patients in the control group were treated with isosorbide dinitrate, while those in the rhBNP group were given rhBNP, all for 5 days. The general data of patients in the two groups were recorded. The hemodynamic indices, such as global ejection fraction (GEF), cardiac index, global end-diastolic volume index (GEDI), systemic vascular resistance index (SVRI), extravascular lung water index (ELWI), mean arterial pressure and central venous pressure, N-terminal pro-brain natriuretic peptide (NT-proBNP) and 24 h urine volume were compared before treatment and 1, 3, 7 d after treatment between the two groups. ResultsThe differences of GEF, cardiac index, GEDI, SVRI, ELWI, mean arterial pressure, central venous pressure, NT-proBNP and 24 h urine volume before treatment and 1, 3, 7 d after treatment were statistically significant between these two groups (F = 20.864, 8.982, 89.286, 102.485, 43.824, 12.562, 10.189, 123.848, 89.264; all P < 0.05). Further pairwise comparison showed that there were significant differences in GEF, cardiac index, GEDI, SVRI, ELWI, mean arterial pressure and central venous pressure 3, 7 d after treatment, and NT-proBNP and 24 h urine volume 1, 3, 7 d after treatment between the rhBNP group and control group (all P < 0.05). In the rhBNP group, the expression levels of GEF (20.6 ± 5.2)%, (28.7 ± 5.2)%, (12.2 ± 4.2)%], cardiac index (2.88 ± 0.36), (3.68 ± 0.42), (2.02 ± 0.46) L·min^-1·m^-2] 3, 7 d after treatment and the 24 h urine volume (1 680 ± 220), (1 868 ± 246), (2 198 ± 228), (1 568 ± 248) mL] 1, 3, 7 d after treatment were much higher than those in the same group before treatment, and were highest on 7 d after treatment (all P < 0.05). The expression levels of GEDI (947 ± 110), (791 ± 110), (1 108 ± 100) mL/m²], SVRI (2 642 ± 508), (2 218 ± 568), (3 289 ± 510) dyn·sec·cm^-5·m²], ELWI (9.3 ± 2.5), (8.6 ± 2.1), (12.3 ± 2.7) mL/kg], mean arterial pressure (73 ± 6), (69 ± 5), (80 ± 6) mmHg] and central venous pressure (8.7 ± 1.4), (7.1 ± 1.3), (12.3 ± 2.1) mmHg] 3, 7 d after treatment, and NT-proBNP (4 829 ± 326), (3 029 ± 298), (2 006 ± 300), (6 979 ± 469) ng/L] 1, 3, 7 d after treatment of patients in the rhBNP group were much lower than those in the same group before treatment, and were lowest on 7 d after treatment (all P < 0.05). ConclusionCompared with isosorbide dinitrate, rhBNP can be more effective in improving the hemodynamics and cardiac function of patients with severe heart failure, which is worthy of promotion in ICU.