重组人脑利钠肽对急性失代偿性心力衰竭患者心率变异性的作用

Effects of Recombinant Human Brain Natriuretic Peptide on Heart Rate Variability in Acute Decompensated Heart Failure

目的观察重组人脑利钠肽（recombinant humand brain natriuretic peptide，rh—BNP）对急性失代偿性心力衰竭（acute decompensated heart failure，ADHF）患者心率变异性（heart rate variability，HRV）的影响。方法将48例ADHF随机分为观察组和对照组，每组各24例。对照组行常规抗心力衰竭治疗，观察组在对照组治疗基础上采用负荷剂量静脉推注rh—BNP（1．5—2．0μg／kg），随后按维持剂量进行微量泵静脉内注射[0．0075～0．0150μg／（kg·min）]，连续静脉滴注24h。两组治疗前后均行24h动态心电图检查，对两组治疗前后心率、HRV时域分析指标，即正常R—R间期的标准差（SDNN）、每5minR．R间期均值的标准差（SDANN）、正常相邻R—R间期差值的均方根（RMSSD）、正常相邻R—R间期差值〉50ms的百分比（PNN50）进行比较。结果观察组治疗后HRV的各项时域分析指标与治疗前比较均有所增加，差异有统计学意义（P〈0．01），对照组治疗后HRV的各项时域分析指标有增加的趋势，但与治疗前比较差异无统计学意义（P〉0．05）；两组治疗后HRV的各项时域分析指标比较差异有统计学意义（P〈0．05）；两组治疗后心率较治疗前比较均减慢，差异有统计学意义（P〈0．01），但组间比较差异无统计学意义（P〉0．05）。结论rh—BNP可改善ADHF患者的HRV，改善心功能。

Objective To study the effect of recombinant human brain natriuretic peptide （rh-BNP） on heart rate variability （HRV） in acute decompensated heart failure （ADHF）. Methods 48 patients with ADHF were randomly divided into observation group and control group with 24 patients in each group. The control group received conventional antiheart failure treatment. Based on the treatment of control group, the observation group was treated with a loading dose of intravenous injection of rh-BNP, and followed by a maintenance dose for intravenous injection micropump and maintained intravenous infusion over 24 h （loading dose： 1.5 - 2.0 μg / kg, maintenance dose： 0. 0075 - 0.0150 μg/kg/min）. Heart rate, HRV time domain analysis indicators, including standard deviation of normal number of intervals （SDNN）, standard deviation of per 5 min averages normal number of intervals（ SDANN）, root mean square values of the standard deviation between adjacent normal number of intervals （RMSSD） , and PNN50 were compared and analyzed with 24-hour electrocardiographic monitoring before and after treatment. Results When compared with that before treatment, the domain HRV parameters and indices in the obseration group increased after treatment, and the difference was statistically significant （ P 〈 0.01 ）. There was an increasing trend of time domain HRV index parameters in the control group, but when compared with that before treatment, it was no significant difference （P 〉0. 05）, and the difference between the two groups was statistically significant（P 〈0. 05） ; After treatment, the heart rate was slower than that before treatment in both the groups, and the difference was statistically significant （ P 〈0. 01 ） , but there was no significant difference between the two groups （ P 〉 0. 05）. Conclusion rh-BNP can significantly improve the heart rate variability in ADHF.