重组人脑利钠肽治疗急性心肌梗死伴心力衰竭的疗效评价

Therapeutic effects of recombinant human brain natriuretic peptide for the treatment of a-cute myocardial infarction complicated with heart failure

目的:研究静脉注射重组人脑利钠肽(rhBNP)治疗急性心肌梗死伴心力衰竭患者的疗效。方法:2006年8月～2008年8月住院的急性心肌梗死伴心力衰竭患者81例,随机分为常规治疗组(n=43)和rhBNP治疗组(n=38),常规治疗组:予病因、强心、利尿、扩血管治疗,rhBNP治疗组:常规治疗基础上加静脉注射rhBNP[90s匀速静脉注射冲击量1.5μg/kg,0.0075μg/(kg·min)维持静脉注射48h]。应用USCOM无创血流动力学监测系统监测各组治疗前、治疗后30min、1、3、6、12、24和48h的血流动力学参数和48h的尿量、血肌酐、血钾、血钠。结果:rhBNP静脉注射后外周血管阻力(SVR)较治疗前下降(P<0.05),每搏输出量(SV)﹑心脏指数(CI)﹑总尿量(UR)较治疗前升高(P<0.05),血肌酐(CR)较治疗前下降(P<0.05),较之常规治疗组的变化更明显。结论:急性心肌梗死伴心力衰竭患者静脉注射rhBNP较之单纯常规治疗有着更好的血流动力学效应和临床效果。

Objective ：To evaluate the hemodynamic effects of intravenous injection of recombinant human brain natriuretic peptide （rhBNP） in patients with acute myocardial infarction complicated with heart failure by non-invasive cardiac output monitor. Methods： Eighty-one consecutive patients who suffered from acute myocardial infarction complicated with beart failure were divided into standard therapy plus rhBNP group（n = 38, 1.5μg/kg bolus intravenous injection followed by 0.0075μg/（kg·min） for following 48 hours） and standard therapy group （n = 43）. The hemodynamic parameters were monitored by USCOM at baseline, and 0.5,1,3,6,12,24, 48 h during infusion. Results： In rhBNP group, systemic vascular resistance （SVR） was lower than the basic value （P 〈 0.05 ）, stroke volume （SV）, cardiac index（CI）, total urine output（UR）.was higher than the basic value（P 〈 0.05） and serum creatinine （CR） was lower than the basic value（P 〈 0.05）; rhBNP group was markedly more effective than conventional treatment group. Conclusion：Intravenous injection of rhBNP combined with other routine treatments can further improve the hemodynamic effects in patients with acute myocardial infarction complicated with heart failure.