强利尿心钠素在急性心肌梗塞治疗中的作用

HEMODYNAMIC AND RENAL EFFECTS OF STRONG DIURETIC ATRIAL NATRIURETIC PEP-TIDE IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

为了解心钠素对急性心肌梗塞（ＡＭＩ）的治疗作用，观察了输注强利尿心钠素对１２例ＡＭＩ病人血流动力学及肾脏排泄功能的影响。给药方法为经一导管先自右心房推注１００μｇ，继以２μｇ／ｋｇ持续灌注，于１０分钟内输注完毕。结果表明，强利尿心钠素引起心脏指数、每搏量指数增高，右房压、肺动脉压、肺毛细血管嵌压、体循环血管阻力和肺循环血管阻力降低，且以用完药即刻最明显；而动脉血压和心率的变化无统计学意义。同时，强利尿心钠素还可使尿量、尿钠、尿氯及尿钾排泄均增加。结论：给ＡＭＩ患者输注强利尿心钠素可引起明显的血流动力学效应，并能防治严重循环容量过度负荷的发生。

he hemodynamic and renal effects of strong diuretic atrial natriuretic peptide(ANP) were investigat-ed in 12 patients with acute myocardial infarction. Strong dluretic ANP was administered as a bolus injec-tion of 100μg and followed by a continuous infusion of 2μg/kg within 10 minutes into the right atrium via a catheter.We found that strong diuretic ANP induced an increase in cardiac index and stroke volume in-dex. Right atrial pressure, pulmonary arterial pressure,pulmonary capillary wedge pressure,systemic vas-cular resistance and pulmonary vascular resistance were decreased after ANP infusion,The maximal re-sponses were ohserved immediately after the infusion was completed.No significant change of arterial blood pressure and heart rate was observed.Furthermore, strong diuretic ANP also increased the urine volume,urinary sodium,urinary chloride and urinary potassium. These results suggest that strong diuretic ANP in-fusion may induce significant changes of hymodynamics and may be used to prevent the development of se-vere circulatory volurne overload in patients with AMI.