重组人脑利钠肽在老年急性失代偿性

Application of rhBNP in elderly patients with acute decompensated heart failure

目的 探讨重组人脑利钠肽（rhBNP）治疗老年急性失代偿性心力衰竭（ADHF）的疗效和安全性.方法 连续入选56例老年急性失代偿性心力衰竭患者,随机分为对照组（28例）和rhBNP组（28例）.对照组给予传统的心衰治疗;rhBNP组在传统治疗基础上,给予rhBNP 0.15 μg/kg,缓慢静脉推注后以0.0075～0.0100 μg·kg-1·min-1持续静脉滴注48 h.比较两组患者治疗后48 h的血压、心率、临床症状改善、心功能、尿量和治疗后2周LVEF及肾功能、NT-proBNP水平.结果 rhBNP组总有效率高于对照组（P＝0.040）.治疗后2周rhBNP组的LVEF较对照组及治疗前显著升高（分别为P＝0.035,P＝0.027）.rhBNP组治疗后48 h及2周时NT-proBNP水平显著低于对照组（分别为P＝0.042,P＝0.029）.两组患者均未发生药物相关的严重不良反应.结论 老年ADHF患者静脉应用rhBNP能够明显改善心衰症状,提高LVEF,且患者耐受性良好.

Objective To study the efficacy and safety of rhBNP in elderly patients with ADHF. Methods A total of 56 elderly patients with ADHF were enrolled continously. The patients were randomly allocat- ed to control group（n=28） and rhBNP group（n=28 ）. Standard treatment of heart failure were given to the patients of both groups, and rhBNP（0.15 txg/kg bolus intravenously injection followed by 0.0075-0.0100 μg·kg-1·min-1 for 48 h） was given to patients in rhBNP group. Blood pressure, heart rate, improvement of symptoms, grade of heart function, urine output, LVEF, renal function and NT-proBNP levels were compared between the two groups. Results The total effective rate was higher in rhBNP group compared to control group （P=0.040）, and LVEF in- creased significantly in rhBNP group after 2 weeks of admission compared with those of control group or levels of rhBNP group on admission （P=0.035, P=0.027, respectively）. The levels of NT-proBNP in rhBNP group after rhBNP therapy 48 h and 2 weeks were significantly decreased compared with control group （P=0.042, P=0.029, respectively）. There were no severe adverse events correlated with drugs in both groups. Conclusion Application of intravenous rhBNP is effective to improve symptoms and LVEF and well tolerated in patients with ADHF.