重组人脑利钠肽治疗急性呼吸窘迫综合征的初步临床观察

Effects of recombinant human brain natriuretic peptide on the patients with acute respiratory distress syndrome

目的评价静脉注射重组人脑利钠肽（rhBNP）对急性呼吸窘迫综合征（ARDS）患者肺通气功能、尿量及肺损伤评分的影响。方法30例ARDS患者随机分为rhBNP治疗组（n=15）和对照组（n=15），rhBNP治疗组在肺保护性通气策略为主的ICU综合治疗基础上持续24h静脉注射rhBNP0．01μg·kg^-1·h^-1；对照组采取肺保护性通气策略为主的综合ICU治疗。比较两组患者治疗前后氧合指数（PaO2／FiO2）、尿量、心率、中心静脉压（CVP）及肺损伤评分、急性生理和慢性健康评分Ⅱ（APACHEⅡ）变化。结果rhBNP治疗组治疗前后心率、CVP无明显变化，PaO2／FiO2、尿量明显增加（P〈0．05），肺损伤评分、APACHEⅡ评分明显降低（P〈0．05）。对照组治疗前后尿量并无增加，PaO2／FiO2、肺损伤评分降低（P〈0．05），两组尿量、PaO2／FiO2、肺损伤评分及APACHEⅡ评分比较差异均有统计学意义（P〈0．05）。结论静脉注射rhBNP能显著改善机械通气ARDS患者的肺通气功能，并有显著利尿作用。

Objective To evaluate the effect of recombinant human brain natriuretic peptide （ rhBNP ） on pulmonary gas exchange, urine volume and lung injury score during mechanical ventilation in the patients with acute respiratory distress syndrome（ARDS）. Methods 30 patients with ARDS who required mechanical ventilation were randomly divided into two groups ： BNP group （ n = 15 ） and control group （n = 15）. The BNP group received rhBNP at the rate of 0. 01 μg · kg^-1 · hour^-1 for 24 h. The control group did not receive BNP. All the patients ＇ arterial blood gas, urine volume, heart rate, central venous pressure （ CVP ）, acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score and lung injury score were measured at baseline and 24 h after the rhBNP infusion. Results In the BNP group, patients＇heart rate and CVP did not change, but PaO2/FiO2 and urine volume significantly increased at 24 h after the rhBNP infusion （ P 〈 0. 05 ）, lung injury score and APACHE II decreased significantly （ P 〈 0. 05）. In the control group, urine volume did not change, but PaO2/FiO2 and lung injury score decreased during the study period （P 〈 O. 05.）. There were significant differences in PaO2/FiO2, urine volume,lung injury score and APACHE Ⅱ score between the two groups （P 〈 0. 05 ）. Conclusion rhBNP infusion induces the diuresis and improves pulmonary gas exchange in the patients with ARDS during mechanical ventilation.