重组人脑钠尿肽对失代偿性心力衰竭患者的疗效

Observation of therapeutic effect of recombinant human brain natriuretic peptide on decompensated heart failure

目的观察静脉用重组人脑钠尿肽（rhBNP）对失代偿性心力衰竭患者的临床疗效。方法我院50例急性失代偿性心力衰竭住院患者随机分为硝普钠组和rhBNP组，分别记录两组患者给药前及给药后0．5h、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。其中硝普钠组使用硝普钠（起始10μg/min，根据血压每10rain增加5μg/min，维持在50—100μg/min），rhBNP组使用rhBNP[首先以1．5μg/kg弹丸式静脉冲击，随后以0．0075μg/（kg·min）连续静脉滴注24h]。结果静脉给药0．5h后rhBNP与硝普钠改善呼吸困难和整体临床状况的程度未见明显差异，6h及24h后rhBNP组患者的呼吸困难好转程度和整体临床状况好转程度显著优于硝普钠组（P〈0．05）；用药24h后rhBNP组的尿量（2014±243）ml明显多于硝普钠组（1341±240）ml（P〈0．05）；用药24h时rhBNP与硝普钠同样能明显增加患者的左室射血分数，以及明显降低肺动脉压和收缩压，但无统计学差异。结论rhBNP能明显改善急性失代偿性心力衰竭患者呼吸困难及整体临床状况。

AIM To observe the effectiveness of intravenous recombinant human brain natriuretic peptide （rhBNP） in the treatment of decompensated heart failure. METHODS Fifty cases of decompensated heart failure patients were randomly divided into rhBNP group and the nitroprusside sodium group. In all the patients, dyspnea and global clinical status were assessed at 0. 5 hours, 6 hours and 24 hours after administration and the input liquid and urine and homodynamic parameters were recorded 24 hours after administration. The nitroprusside sodium group used nitroprusside sodium with initial 10 μg per minute, increase of 5 μg per minute every 10 minutes based on blood pressure, maintaining at 50 - 100 μg per minute. The rhBNP group used rhBNP with initial 1.5μg per kilogram of body weight bolus intravenous, followed by an infusion of 0. 0075μg per kilogram of body weight per minute for 24 hours. RESULTS The difference of the improved level of dyspnea and global clinical status between the rhBNP group and the nitroprusside sodium group were not significant at 0.5 h, but significant difference of both were observed at 6 hours and 24 hours after administration （P 〈 0. 05 ）. After 24 hours of treatment, the urine of the rhBNP group （2 014 ± 243 ml）was significantly higher than that of the nitroprusside sodium group （1 341 ±240 ml）（P 〈0.05 ）while the difference in reduction of pulmonary artery pressure and systolic blood pressure and the increase in ejection fraction of the rhBNP group was not significant compared with that of the nitroprusside sodium group. CONCLUSION rhBNP promotes the excretion of urine, decreases pulmonary artery pressure and increases left ventricular ejection fraction, rhBNP significantly improves dyspnea and global clinical status of patients with decompensated heart failure.