重组人脑利钠肽治疗高龄顽固性心力衰竭

Effects of Recombinant Human Brain Natriuretic Peptide in Elderly Patients with Refractory Heart Failure

目的:研究重组人脑利钠肽治疗高龄顽固性心力衰竭患者的有效性及安全性。方法:以我科住院的56例高龄顽固性心力衰竭患者为研究对象,将其随机分为治疗组和对照组,对照组在应用血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)或血管紧张素受体拮抗剂(angiotensin receptor blocker,ARB)、地高辛、螺内酯、他汀类等药物的基础上,予以静脉泵入硝普钠,治疗1周;而治疗组则给予持续静脉泵入重组人脑利钠肽,治疗1周。分别于治疗3、7 d后观察两组患者心力衰竭症状的改善情况,并观察两组患者左室射血分数(left ven-tricular ejection fraction,LVEF)、血浆NT-proBNP、尿量、日常生活活动量表(Barthel指数);治疗期间每日监测治疗组的尿素氮(BUN)、肌酐(Cr)、血管收缩压(SBP)等指标。结果:与对照组相比,治疗组患者治疗有效率显著提高,左室射血功能改善、尿量增加、心脏负荷减轻,日常生活能力改善,差异有统计学意义(P<0.05);治疗期间对患者肾功能无明显影响,血压虽有轻度下降,但不影响重要器官的灌注。结论:重组人脑利钠肽治疗高龄顽固性心力衰竭患者是有效、安全的。

Objective To investigate the efficacy and safety of recombinant human brain natriuretic peptide in elderly patients with refractory heart failure.Methods Total 56 hospitalized elderly patients with refractory heart failure were randomly divided into treatment group and control group.All the patients were treated with angiotensin converting enzyme inhibitors(ACEI) or angiotensin receptor blocker(ARB),digoxin,spironolactone,statins,etc.In addition,treatment group and control group were given recombinant human brain natriuretic peptide and sodium nitroprusside by venous pump for one week,respectively.The improvement of heart failure symptoms,left ventricular ejection fraction(LVEF),plasma NT-proBNP,urine volume,Barthel index in both groups were observed at 3,7 d after treatment.The blood urea nitrogen,serum creatinine and systolic blood pressure were monitored daily.Results Compared with control group,the effective rate and Barthel index were higher,LVEF was obviously improved,urine volume was significantly increased and cardiac load was significantly reduced in treatment group(all P<0.05).Although the systolic blood pressure declined mildly in treatment group,it had no influence on the perfusion of important organs and the renal function.Conclusion Recombinant human brain natriuretic peptide is effective and safe for treating elderly patients with refractory heart failure.