重组人脑利钠肽治疗急性失代偿性心力衰竭的疗效及安全性

Efficacy and safety of recombinant human brain natriuretic peptide for treating acute decompensated heart failure

目的:探讨国产重组人脑利钠肽(rhBNP)治疗急性失代偿性心力衰竭的疗效及安全性。方法:收集2005年1月至2006年3月,住院用rhBNP治疗的15例急性失代偿性心力衰竭患者的临床资料。用药方法为:先给予rhBNP1.5μg/kg负荷剂量,于1～3min内静脉推注,继以0.0075μg/(kg.min)的速率维持泵入25.9～46h,用药总剂量1.0mg。回顾性比较患者用药前后,BP、HR、R、尿量、血清肌酐(SCr)、BNP和左心室射血分数(LVEF)的变化,分析rhBNP的疗效及安全性。结果:结束用药时15例患者的呼吸困难均有不同程度缓解,呼吸由(35.2±6.1)次/min降低至(24.4±5.0)次/min,但P>0.05;尿量由(1452.7±1611.9)ml/d增加至(2149.4±1279.6)ml/d,呋塞米用量由(86.0±77.2)mg/d减少至(40.0±28.2)mg/d,HR由(97.4±29.9)次/min减慢为(79.8±15.0)次/min(均P<0.05)。停药24h,上述症状进一步改善(均P<0.05)。2例患者使用rhBNP后室性心律失常明显减少。患者血压轻度下降,但用药前后的差异无统计学意义(P>0.05),SCr、BNP、LVEF亦无明显变化。3例患者住院期间死亡(2例死于多脏器衰竭,1例死于心室颤动);8～32周随防期间11例存活,1例死亡(死于消化道出血)。结论:国产rhBNP能迅速缓解急性失代偿性心力衰竭的临床症状,患者耐受性良好,可用作心力衰竭急性期的治疗。

Objective：To study the eflqcacy and safety of domestic recombinant human brain natriuretic peptide （rhBNP） for treating acute decompensated heart failure. Methods： The clinical data of 15 inpatients with acute decompensated heart failure from January 2005 to March 2006 were collected. The patients received rhBNP 1.5 μg/kg by bolus intravenous injection within 1 - 3 minutes followed by 0. 007 5μg/（kg · min） for 25.9 -46 hours（ total dosage 1.0 mg）. The changes in BP, H R, respiration rate, urinary output, SCr, BNP, and left ventricular ejection fraction （LVEF） were compared before and after treatment. Results： Dyspnea in the 15 patients was improved in varying degrees. Respiration rate decreased from（ 35.2 ± 6.1 ） breaths/min to （24.4 ± 5.0） breaths/min （ P 〉 0. 05 ）. Urine output increased from（ 1 452.7 ± 1 611.9） ml/d to （2 149.4 ± 1 279.6） mg/d, and the dose of furosemide was decreased from （86.0 ± 77.2） mg/d to （40.0 ± 28.2） mg/d. Heart rate decreased from （97.4 ± 29.9） beats/min to （79.8 ± 15.0） beats/min （all P 〈0. 05）. After 24 hours of stopping rhBNP, the symptoms were improved further（all P 〈0. 05）. Ventricular arrhythmia in 2 patients was markedly improved. The patients developed mild blood pressure decreasing , but the difference was no statisticadly significant before and after treatment （P 〉0. 05）. There were no changes in SCr, BNP, and LVEF. Three of the 15 patients died in hospitalization. Of the 3 patients, 2 cases died from muhiorgan failure and 1 case died from ventricular fibrillation. At follow-up of 8 -32 weeks, 11 cases survived and 1 case died from gastrointestinal hemorrhage. Conclusion： Domestic rhBNP can relieve the clinical symptoms of acute decompensated heart failure. It demonstrates good tolerance in treatment of acute decompensated heart failure.