rhBNP对重症心脏瓣膜病术后血流动力学效应的影响

Influence of recombinant human brain natriuretic peptide on postoperative hemodynamics in patients with severe valvular heart disease

目的探讨重组人脑利钠肽(rhBNP)对重症心脏瓣膜病患者术后血流动力学效应及用药安全性。方法 38例入选的重症瓣膜病患者随机化分为rhBNP组(n=21)和对照组(n=17)。各组术前均经右侧颈内静脉置入Swan-Ganz导管进行血流动力学指标监测[肺毛细血管楔压(PCWP)、平均肺动脉压(mPAP)、心排指数(CI)]。术后监护室治疗方案:对照组予以常规强心扩血管药物治疗,rhBNP组给予rhBNP及强心药物治疗同时不再给予扩血管治疗。rhBNP给药方式:首先以1.5μg/kg负荷剂量冲击,再以0.0075μg/(kg·min)持续静脉滴注24 h。以rhBNP组静脉给药前及给药后0.5、1、3、6、12、24 h为时间节点,测定各组血流动力学指标。记录用药过程中所有不良事件,以评价药物安全性。结果 rhBNP组较对照组PCWP在给药后0.5、1、3、6 h时间节点有显著下降(P<0.05),mPAP在给药后各时间节点均有显著下降(P<0.05),而CI在给药后1、3、6 h时间节点显著上升(P<0.05)。在药物不良事件方面,两组差异无统计学意义。结论 rhBNP能明显改善重症心脏瓣膜病患者术后血流动力学效应,进而改善心脏功能,且用药安全性良好。

Objective To discuss the influence of recombinant human brain natriuretic peptide （rhBNP） on postoperative bemodynamies in patients with severe valvular heart disease and its medication safety. Methods Thirty eight patients with severe valvular heart disease were randomly divided into rhBNP group（ n = 21 ）and control group（ n = 17 ）. Before the operation, Swan-Ganz catheters were placed in all the patients via the right side internal jugular vein in order to measure the hemodynamic parameters such as pulmonary capillary wedge pressure （PCWP）, mean pulmonary arterial pressure （mPAP）, and cardiac index （CI）. Each patient accepted the treatment in intensive care unit after the operation. The control group accepted the treatment with routine strong heart vasodilators, while the rhBNP group accepted the treatment with rhBNP [ 1.5 μg/kg bolus intravenous injection followed by 0. 0075 p.g/（ kg ·min） for 24 h ] and eardiotonic and did not receive the vasodilator treatment. The hemodynamic parameters were measured before the administration of the rhBNP group and at the time points of 0. 5,1,3,6, 12, and 24 h after the intravenous infusion. During the administration, all adverse events were recorded in order to evaluate its safety. Results Compared with the parameters of the control group, the PCWP and the mPAP of the rhBNP group significantly decreased at the time points of 0.5, 1,3, and 6 h after the administration（P 〈0.05）, while the CI significantly increased at 1,3, and 6 h after the administration （P 〈 0.05 ）. There was no significant difference in the drug adverse events between the two groups. Conclusion RbBNP can significantly improve the hemodynamics and cardiac function of the patients with severe valvular heart disease with good safety.