重组人脑利钠肽单用或联合硝普钠对急性心力衰竭疗效及肾功能的影响

【目的】观察重组人脑利钠肽单用及联合硝普钠治疗急性心力衰竭患者的疗效和安全性。【方法】本院60例急性心力衰竭患者，随机分为重组人脑利钠肽组（A组）、硝普钠组（B组）、重组人脑利钠肽联合硝普钠组（C组），每组20例，在常规治疗的基础上，分别按三组用药持续治疗72h，比较3组患者治疗前后的临床症状、心功能及血清N末端脑利钠肽前体（NT-proBNP）、肾功能等指标的变化。【结果】治疗后三组患者临床症状均明显改善，总有效率组间均无明显差异（P〉0．05）；治疗后A、B、C三组间NT—proBNP较治疗前明显下降（P〈0．05），A、C组下降幅度显著高于B组（P〈0．01），A、C组问无明显差异（P〉0．05）；A、C组患者用药前后内生肌酐清除率变化差值为（16．8±3．8）mL／min与B组（10．3±2．6）mL／min相比有明显差异（P〈0．05）；基础肾功异常组内生肌酐清除率前后比较无明显差异（P〉0．05）。【结论】：与单用硝普钠比较，rh—BNP无论单用或联用硝普钠均能够进一步改善急性心力衰竭患者NT—proBNP指标，同时对肾功能无明显损害，安全性与硝普钠无明显差异。

Efficacy of Recombinant Human Brain Natriuretic Peptide Alone or Combined with Nitroprus- side for the Treatment of Acute Heart Failure and Their Effect on Renal Function

Objective] To observe the efficacy and safety of recombinant human brain natriuretic peptide（rh- BNP） alone or combined with sodium nitroprusside（SNP） for the treatment of patients with acute heart failure. MethodslSixty patients with acute heart failure admitted to our hospital from Jan. 2010 to Jan. 2011 were chosen and randomly divided into rh-BNP group（group A, n = 20）, SNP group（group B, n = 20） and rh-BNP in combina- tion with SNP group（group C, n = 20） with 20 cases in each group, On the basis of conventional treatment, 3 groups were additionally given rh-BNP or/and SNP respectively for continuous 72h. Clinical symptoms, heart function, ser um NT-proBNP and renal function of 3 groups were observed before and after treatment. Resultslclinical symptoms were improved in all 3 groups after treatment; There was no significant difference among the three groups（ P〉0. 05）. Compared with before treatment, the level of NT-proBNP in all three groups decreased after treatment（ P 〈0. 05）, and the decrease of group A and group C was markedly higher than that of group B（ P 〈0.01）, but there was no obvious difference between group A and group C（ P 〉0. 05）. The incidence of hypotension of SNP was higher than that of other two groups, but there was no significant difference（ P 〉0.05）. The change value of endogenous creatinine clearance rate before and after treatment in group A and group C was （16.8 ±3.8）mL/min, and there was significant difference between group A or group C and group B（10.3±2.6mL/min）（ P 〈0.05）. The endogenous creatinine clearance rate in patients with baseline renal dysfunction before and after treatment was （54. 6 ±13.7）mL/ min and （58. 3±12.3）mL/min, respectively, but there was no significant difference（ P〉0.05）. Conclusionl Corn pared with SNP alone, rh-BNP alone or combined with SNP can further improve the level of NT-proBNP in patients with acute heart failure patients, meanwhile not deteriorate the renal function. The safety of combined therapy is similar to SNP alone.