国产冻干重组人脑利钠肽应用于难治性冠心病心力衰竭患者临床疗效观察

Clinical effects of lyophilize recombinant human brain natriuretic peptide in patients with refractory heart failure caused by coronary artery disease.

目的观察国产冻干重组人脑利钠肽（rhBNP）治疗难治性冠心病心力衰竭的临床疗效。方法入选7例难治性冠心病心力衰竭患者在常规治疗基础上，予国产冻干rhBNP，同时停用其他静脉扩血管药物。rhBNP冲击量以1．5μg/kg在60～90s匀速静脉注射，继以0．0075—0．01μg／（kg·min）持续静脉注射48—72h。分别在给药0、15、30min和1、2、4、8、12、24、48h记录呼吸困难程度、尿量、全身临床状况、心率及血压，并测量中心静脉压，测定治疗前后血钾、血钠、血肌酐、血浆BNP。结果经国产冻干rhBNP治疗，7例患者中按呼吸困难程度评估5例好转，按临床状况评估6例好转。治疗15min时收缩压较治疗前有所下降[（105．14±7．76）比（112．00±10．42）mmHg，P〈0．05]，30min后收缩压为（108．71±6．63）mmHg恢复至治疗前水平。治疗前后心率[（88．57±16．92）比（86．00±16．21）次／min]、血钠[（133．57±5．38）比（133．57±8．16）mmol／L]、血钾[（3．83±0．37）比（4．19±0．58）mmol／L]、血肌酐[（93．11±27．90）比（123．01±93．01）μmol／L]及治疗前与治疗24h时血浆BNP[（1218．43±847．83）比（1433．71±676．08）ng／L]比较差异均无统计学意义（P均〉0．05）。治疗前后尿量比较差异无统计学意义[（2329±1573）比（2126±1074）ml，P〉0．05]，但利尿剂用量明显减少。中心静脉压于治疗30min～48h均较前逐渐下降（P均〈0．05）。结论国产冻干rhBNP治疗难治性冠心病心力衰竭有较好的临床疗效，能有效降低中心静脉压，增加尿量，而对电解质及肾功能没有明显影响。

Objective To examine the clinical effects of intravenous lvoDhilize recombinant human brain natriuretic peptide （rhBNP） in patients with refractory heart failure caused by coronary artery disease. Methods Seven patients with refractory heart failure caused by coronary artery disease were treated with rhBNP. The rhBNP was intravenously administrated 1.5 μg/kg bolus injection and 0. 0075-0.01 μg/（ kg · min） for 48-72 hours）. Dyspnea grade,symptoms and signs ,24 hours urine output,heart rate ,blood pressure and central venous pressure were evaluated at 0, 15,30 rain and 1,2,4,8,12,24, and 48 h. Serum potassium, sodium, creatinine and plasma BNP before and after treatment were measured. Results After rhBNP therapy, dyspnea grade were improved in 5 patients. Symptoms and signs got better in 6 patients. Systolic blood pressure at 15 min of treatment distolic blood pressure was decreased slightly from （112.00 ± 10. 42） mm Hg to （105. 14 ±7.76） mm Hg （P 〈0. 05） and became （108.71 ±6.63 ）mm Hg at 30 min which was the same with that before treatment. There was no statistical significance in heart beat[ （88.57 ± 16.92） vs. （ 86. 00 ± 16.21 ） ] beat/min, serum sodium [ （ 133.57 ± 5.38 ） mmol/L vs. （133.57 ± 8.16）mmol/L ], serum potassium[ （3.83 ± 0. 37 ）mmol/L vs. （4.19 ± 0. 58 ）mmol/L ] , creatinine [ （93.11 ± 27.90） μmol/L vs （ 123.01 ± 93.01 ） μmol/L ] before and after treatment, and BNP[ （ 1218.43 ± 847.83 ） vs. （1433.71 ± 676.08 ）ng/L] before treatment and at 24 h treatment, as well as urine output [ （2329 ± 1573 ） vs. （2126 ±1074 ）ml ] （P 〉 0.05 ）. Urine output was increased during the treatment, but the usage of diuretic was remarkably decreased. Central venous pressure was gradually decreased from 30 min to 48 h（ P 〈 0. 05 ）. Conclusion rhBNP can decrease central venous pressure and increase urine output with exerts little side effects on electrolytes and renal function. Therefore rhBNP has positive clinical effects on refractory heart failure which is caused by coronary artery disease.