米力农治疗充血性心力衰竭前后B型钠尿肽的变化

Changes of B-type natriuretic peptide in congestive heart failure treated by milrinone

目的观察充血性心力衰竭(CHF)患者米力农治疗前后B型钠尿肽(BNP)的变化。方法89例CHF NYHA心功能Ⅲ~Ⅳ级患者,分为常规治疗组43例(ACE抑制药、利尿药、地高辛);米力农组46例,在常规治疗基础上应用米力农50 mg.kg-1加NS 20 mL稀释后,10 min内iv,继以0.75μg.kg-1.min-1持续iv gtt,qd,共用7 d。治疗前后评估心功能,测定BNP,同时查胸片测量心胸比率,超声心动图测量左室舒张末期内径(LVEDD),射血分数(EF)。结果2组BNP均有显著下降,米力农组BNP下降更显著(P<0.01),但心胸比率、LVEDD和EF变化不明显。结论米力农治疗CHF短期内可使BNP明显下降,比传统的心胸比率、心脏超声参数能更敏感地反映治疗后心功能的变化。

AIM To evaluate the changes of plasma levels of B-type natriuretic peptide (BNP) in patients with congestive heart failure (CHF) treated by milrinone.METHODS Eighty-nine patients with CHF(NYHAⅢ-Ⅳ) were randomly divided into treatment group(n=46) and control group(n=43),the control group received basic therapy: angiotensin-converting enzyme inhibitor, diuretic and digoxin,the threatment group received milrinone with an initial 50 (mg·)kg^(-1) bolus followed by a 0.75 μg·kg^(-1)·min^(-1)·d^(-1),ivgtt,for 7d in addition to basic therapy. The therapeutic effects were assessed by the changes of the following parameters: levels of B-type natriuretic peptide from blood samples, left veatricular end-diastolic diameter (LVEDD) and ejection fraction(EF) from echocardiography, cardiothoracic ratio.RESULTS BNP levels decreased in both groups, BNP levels in treatment group decreased more significant than those in control group. While cordiothoratic ratio, LVEDD and EF had no significant change.CONCLUSION The BNP concentration of heart failure could be reduced markedly by short ferm use of intravenous milrinone. The BNP concentration could be used to assess the effect of milrinone on CHF and the level of BNP is a more sensitive agent to assess the severity of heart failure than those traditional parameters such as cardiothoracic ratio, LVEDD and EF.