硝酸甘油和重组人脑利钠肽对急性失代偿性心力衰竭的疗效比较

Therapeutic effect of recombinant human brain natriuretic peptide for treatment of decompensated heart failure:comparison with nitroglycerin

目的比较重组人脑利钠肽(rhBNP)和硝酸甘油对失代偿性心力衰竭的临床疗效。方法我院50例失代偿性心力衰竭住院患者随机分为硝酸甘油组和rhBNP组,分别记录两组患者给药前及给药后30min、6h及24h的呼吸困难程度以及整体临床情况,以及用药24h后液体的出入量和血流动力学参数。其中硝酸甘油组使用硝酸甘油开始剂量为5μg/min,每3～5分钟增加5μg/min,根据个体的血流动力学参数来调整用量;rhBNP组使用rhBNP,首先以1.5μg/kg弹丸式静脉冲击,随后以0.0075μg·kg-1·min-1连续静脉滴注72h。结果rhBNP组患者静脉给药后30min和6h的呼吸困难好转程度(P值分别为0.042和0.019)和整体临床状况好转程度(P值分别是0.018和0.044)均显著优于硝酸甘油组,24h后两组未有明显差异(P值分别是0.192和0.179);用药24h后的尿量rhBNP组(1513.8±242.9)ml明显多于硝酸甘油组(1341.2±239.7)ml(P=0.015);用药24h时rhBNP组患者射血分数的增加以及肺动脉压和收缩压的降低均明显多于硝酸甘油组(P值分别是0.001、0.000及0.002),用药72h后rhBNP组室性期前收缩、成对期前收缩和阵发性室性心动过速等室性心律失常发作的次数明显减少(P值分别是0.000、0.001和0.002)。结论rhBNP通过促进尿量的排泄、降低肺动脉压及增加左室射血分数等途径明显改善失代偿性心力衰竭患者呼吸困难和整体临床状况,以及明显减少室性心律失常的发作。

Objective To compare the therapeutic effect of recombinant human brain natriuretic peptide （rhBNP） and nitroglycerin on acute decompensated heart failure （ADHF）. Methods Fifty ADHF patients were randomly divided into rhBNP group and nitroglycerin group. In all the patients, dyspnea and global clinical status were assessed before and at 30 min, 6 h and 24 h after drug administration, and the volume of fluid intake and urine along with hemodynamic parameters was recorded 24 h after drug administration. In the nitroglycerin group, the patients received an initial nitroglycerin dose of 5μg/min, with subsequent dose increment of 5 μg/min every 3 to 5 min; the dose was adjusted individually according to the hemodynamics of the patients. The patients in rhBNP group were given rhBNP at the initial dose of 1.5 μg/kg by with an intravenous bolus injection followed by infusion at the rate of 0.0075 μg·kg^-1 .min1 for 72 h. Results At 30 min and 6 h after drug administration, the patients in the rhBNP group showed significant greater improvement of dyspnea （P=0.042 and 0.019） and global clinical status （P=0.018 and 0.044） than those in the nitroglycerin group, but 24 h after drug administration, no significant difference was noted between the two groups （P=0.192 and 0.179）. Twenty-four hours after drug administration, the mean urine volume was significantly greater in rhBNP group than in nitroglycerin group （1513.8±242.9 vs 1341.2±239.7 ml, P=0.015）, and the ejection fraction increased and pulmonary arterial pressure and systolic blood pressure decreased at greater amplitude in the former group （P=0.001,0.000 and 0.002, respectively）. At 72 h, the numbors of premature ventricular contraction and couplets premature beats and onset of paroxysmal ventricular tachycardia were significantly reduced in rhBNP group as compared with the nitroglycerin group （P=0, 0.001 and 0.002, respectively）. Conclusion RhBNP promotes urine excretion, decreases pulmonary arterial pressure and increases left ventricular ejection fraction to improve dyspnea and global clinical status and reduce the onset of ventricular arrhythmia in ADHF patients.