重组人脑钠肽在急性左心衰患者中的临床应用研究

Clinical application of rhBNP in patients with acute left heart failure

目的观察重组人脑钠肽对急性失代偿性左心衰患者心肾功能及血流动力学的影响。方法纳入2009年7月～2011年4月我院急性左心衰患者89例,随机分为对照组(n=41)和治疗组(n=48)。对照组予吗啡、速尿、西地兰静脉注射,维持硝普钠静脉微量泵注射至症状缓解后持续12小时,治疗组在对照组治疗的基础上联合重组人脑钠肽3～5天治疗,观察两组间住院期间症状缓解时间、血压、肺动脉楔压(PCWP)、心功能、住院期间和出院6个月后肾功能的变化和6个月内再次入院率。结果两组症状缓解时间分别为4.3h和4.0h,差异无统计学意义。治疗组低血压发生率高于对照组(52.1%vs.26.8%,P<0.05),且治疗组肺动脉楔压(PCWP)早期下降幅度较大[(8.7±2.5)mmHgvs.(3.5±1.5)mmHg,P<0.05]。但两组心功能指标和住院期间以及治疗后6个月的肾功能指标之间均无统计学意义,两组6个月内再入院率亦无差异(60.4%vs.73.2%,P>0.05)。结论联合重组人脑钠肽治疗并不增加心力衰竭患者获益,且较常规治疗更易导致低血压的发生。

Objective To observe the influence of recombinant human brain natriuretic peptide （ rhBNP ） on heart function, kidney function and hemodynamics in the patients with acute decompensated left heart failure. Methods The patients （ n=89 ） were selected from July, 2009 to Apr. 2011, and then randomly divided into control group （ n =41 ） and rhBNP group （ n =48 ） . Control group was given intravenous injection of morphine, furosemide and cedilanid, and maintenance intravenous micro-pump injection of sodium nitroprusside for 12 hours after symptoms relieved, and rhBNP group was given rhBNP for 3 to 5 days besides the same treatment as control group. The time of symptom relieving, blood pressure, pulmonary artery wedge pressure （ PCWP ） , heart function, changes of kidney function during hospitalization and 6 months after discharging, and readmission within 6 months were observed in two groups. Results The time of symptom relieving was 4.3 h and 4.0 h respectively in two groups and the difference had no statistical significance. The incidence rate of hypotension was higher in rhBNP group than that in control group （ 52.1% vs . 26.8%, P 0.05 ） , and PCWP reduced greatly in rhBNP group at early stage [ （ 8.7 ± 2.5 ） mmHg vs . （ 3.5 ± 1.5 ） mmHg, P 0.05]. The differences in LVEF, LVEDD, LVESD, and BCr, BUN, pro-BNP and UCr during hospitalization and 6 months after discharging had no statistical significance between two groups. There was no difference in readmission rate within 6 months between two groups （ 60.4% vs . 73.2%, P 0.05 ） . Conclusion Combined rhBNP treatment can not improve the curative effect in the patients with heart failure, and is more likely cause the incidence of hypotension.