重组人脑利钠肽治疗失代偿性心力衰竭的临床观察

Effect of rhBNP on patients with decompensated heart failure

目的：观察重组人脑利钠肽（rhBNP）治疗失代偿性心力衰竭（DHF）的临床效果。方法：选择心功能分级（NYHA）Ⅲ-Ⅳ级的DHF患者41例，随机分为rhBNP治疗组和对照组[硝酸甘油（NIT）]，观察2组患者治疗前后及治疗后3d生命体征，心功能分级，相关心功能指标及血浆脑利钠肽（BNP）浓度的变化。结果：1．2组治疗前后左心室舒张末期内径（LVDD）无明显变化（P〉0．05）。2．患者心率（HR）均明显下降（P〈0．05）；治疗后3d，rhBNP组HR仍维持较低（P〈0．05）。3．治疗后3d内，rhBNP组尿量较NIT组明显增多（P〈0．05）：4．患者左心室射血分数（LVEF）均有提高（P〈0．05），且rhBNP组升高更明显（P〈0．05）；治疗后3d，rhBNP组仍有改善（P〈0．05）。5．患者NYHA分级均降低（P〈0．05）；治疗后3d，2组NYHA分级仍较低（P〈0．05）。6．治疗后3d，患者血浆BNP水平均有下降（P〈0．05），且rhBNP组下降更明显（P〈0．05）。结论：rhBNP可明显改善DHF患者的心功能，其近期效果优于常规NIT治疗。

Objective：To observe the effect of recombinant human brain natriuretic peptide （rhBNP） on patients with decompensated heart failure. Method ： Forty one decompensated heart failure patients of Ⅲ-Ⅳ New York Heart Association （NYHA） functional classification were randomized into rhBNP group （1.5μg/kg bolus intravenous injection followed by 0. 0075 μg·kg^-1·min^-1 for 48 hrs ） and NIT group（5μg/min intravenous injection and add 5μg/min later till the symptom relax then followed for 48 hrs）, all the patients were treated with traditional heart failure treatment. Observed the change of heat function and BNP level during the treatment. Result： 1. LVDD remained unchanged during the treatment of rhBNP and NIT （ P 〉0.05 ）. 2. HR were decreased obviously after rhBNP or NIT infusion（ P 〈 0.05）, and no significant difference between them（ P 〉 0.05） ; HR remained in rhBNP group（ P 〈 0.05） and increased in NIT group（ P 〉 0.05） 3 days later. 3. The total urine output for 48 hrs in rhBNP group tended to be higher than NIT group（ P 〉 0.05）, and it was more higher for 3 days（ P 〈 0.05）. 4. Both LVEF were increased after rhBNP or NIT infusion（ P 〈 0.05）, and the rhBNP group was better（ P 〈 0.05） ; LVEF remained the same in the rhBNP group（ P 〈 0.05） but descend slightly in the NIT group（ P 〉 0.05） 3 days later. 5. NYHA functional classification were decreased after rhBNP or NIT infusion （ P 〈 0.05）, and no significant difference between them（ P 〉 0.05） ; NYHA functional classification keeps the same in rhBNP group and NIT group（ P 〈 0.05） 3 days later, but the rhBNP group was better（ P 〈 0.05）. 6. BNP level were decreased after rhBNP or NIT infusion 3 days later（ P 〈 0.05）, and the rhBNP group was better（ P 〈 0.05）. Conclusion：The rhBNP can improve heart function of patients with decompensated heart failure obviously, and the short - term effect is better than that of NIT.