治疗急性失代偿性心力衰竭新药奈西立肽

B型利钠肽由于其在诊断、预后及治疗心力衰竭的特殊价值而备受关注.奈西立肽已成为治疗急性失代偿性心力衰竭的一线药物,它能迅速降低急性失代偿性心力衰竭患者肺毛细血管楔压和周围血管压力,提高心脏每搏输出量、心脏指数,并产生利钠利尿及阻滞肾素-血管紧张素-醛固酮系统的作用.其扩张血管作用呈剂量依赖性,且不引起反应性心动过速,能显著改善呼吸困难等临床症状,与多巴酚丁胺相比疗效相似,但较少引起心律失常;较硝酸甘油更安全有效.其主要不良反应是剂量依赖性的低血压、头痛和腹痛.

Nesiritide: a safe and effective agent for acute decompensated heart failure

B-type brain natriuretic peptide (BNP) that is a cardiac neurohormone specifically secreted from the cardiac ventricles is making more attractive thanks to its clinical interests in diagnosis, prognosis and treatment of heart failure. Nesiritide,a recombinant form of human B-type natriuretic peptide (hBNP), has been the first of this drug class to be made available for the intravenous treatment of subjects with acute decompensated heart failure who have shortness of breath at rest or with minimal activity. The clinical data demonstrated that nesiritide produced dose-dependent reductions in pulmonary capillary wedge pressure (PCWP) and systemic arterial pressure in subjects with heart failure, as well as to increases in the heart's pumping strength and cardiac index and suppression of the reninangiotensin-aldosterone axis. Nesiritide has unique vasodilator, natriuretic, diuretic and indirect inotropic properties but less likely than dobutamine to increase heart rate and provoke ventricular arrhythmias, and doesn't have the proarrhythmic effect. Nesiritide was also found to be more rapidly effective and better tolerated than nitroglycerin. The common side effects are dose-dependent hypotension, headache and abdominal pain.