重组人脑钠肽治疗心力衰竭的临床疗效

Clinical efficacy of recombinant human brain natriuretic peptide on heart failure

目的观察重组人脑钠肽(rhBNP)治疗急性心力衰竭或慢性心力衰竭急性发作患者的临床疗效。方法纳入65例急性或慢性心力衰竭急性发作患者,随机分为观察组(n=33)和对照组(n=32)。在常规抗心衰治疗的基础(利尿剂、血管紧张素转换酶抑制剂、β受体阻滞剂等)上,观察组给予rhBNP治疗,首先静脉推注负荷剂量1.5μg/kg,随后以0.0075μg/(kg.min)维持静脉泵注48 h;对照组患者给予静脉泵入硝酸甘油治疗,起始剂量5～10μg/min,根据血压情况每次增加5～10μg,直至临床效应平均用量20μg/min,静脉泵入48h。观察两组患者的治疗效果及左室射血分数(LVEF)、血清N端脑钠肽前体(NT-proBNP)、肺动脉压(PAP)、心率、呼吸、住院时间、死亡率、3个月后6分钟步行距离及再住院率情况。结果观察组和对照组患者的总有效率分别为96.9%、68.8%,差异有统计学意义(P<0.05)。治疗前两组患者LVEF、血清NT-proBNP浓度及心率、呼吸频率、肺动脉压,无显著统计学差异(P>0.05)。治疗48h后,观察组患者LVEF增加,血清NT-proBNP浓度心率、呼吸频率及肺动脉压降低,治疗前后有统计学差异(P<0.05)。而对照组患者上述指标在治疗前后比较,无统计学差异(P>0.05)。与对照组患者相比,观察组患者住院时间明显缩短、住院死亡率降低、3个月后6分钟步行距离增加并且再住院率降低,差异均有统计学意义(P<0.05)。结论早期应用rhBNP治疗急性心力衰竭或慢性心力衰竭急性发作,能更好的改善患者的症状及愈后,疗效优于硝酸甘油。

Objective To observe the clinical efficacy of recombinant human brain natriuretic peptide （rhBNP） on acute heart failure or acute attacked chronic heart failure （CHF）. Methods The patients （n=65） were randomly divided into observation group （n=33） and control group （n=32）. On the base of routine treatment for heart failure （diuretics, ACE inhibitor,β-receptor blockers, etc.）, observation group was given rhBNP [first dose=1.5μg/kg, maintaining dose=0.0075μg/（kg.min）], and control group was given nitroglycerin （first dose=5-10μg/min, increased 5μg-10μg according blood pressure until average dose=20μg/min） by intravenous pumping for 48 h. The clinical efficacy and changes of LVEF, NT-proBNP, pulmonary artery pressure （PAP）, heart rate （HR）, respiratory rate （RR）, length of hospital stay, mortality, 6-minute walk distance （6MWD） after 3 m and rehospitalizing rate were observed in 2 groups. Results The total effective rate was 96.9%in observation group and 68.8%in control group （P〈0.05）. Before treatment the changes of LVEF, NT-proBNP, HR, RR and PAP had no statistical difference between 2 groups （P＆gt;0.05）. After treatment for 48 h, LVEF increased, and NT-proBNP, HR, RR and PAP decreased in observation group （P〈0.05）, while in control group, all above indexes had no statistical difference before and after treatment （P〉0.05）. The length of hospital stay was shortened significantly, mortality decreased, 6MWD after 3 m incrased and rehospitalizing rate decreased in observation group compared with control group （P〈0.05）. Conclusion The early administration of rhBNP can relieve symptoms and improve prognosis in the patients with acute heart failure or acute attacked CHF, and its curative effect is better than that of nitroglycerin.