不同剂量重组人脑利钠肽治疗难治性心力衰竭的疗效分析

目的评价不同剂量冻干重组人脑利钠肽(recombinant human brain natriuretic peptide,rhBNP)治疗难治性心力衰竭(RHF)的临床疗效。方法四川省仁寿县人民医院将80例经常规抗心力衰竭药物治疗无明显改善的RHF患者随机分为小剂量组(n=36)和大剂量组(n=44)。首次负荷剂量1.5μg/kg静脉推注后,小剂量组以0.0075μg/(kg·min)继续静脉泵入维持治疗48h,大剂量组以0.01μg/(kg·min)维持治疗48h。观察2组患者治疗后心功能改善情况,以及24h尿量、左室射血分数(LVEF)和血浆脑钠肽(BNP)水平。结果 2组心功能改善总有效率分别为80.6%、88.6%,差异无统计学意义。使用不同剂量rhBNP治疗后,2组患者24h尿量较用药前明显增多,LVEF明显增加、血浆BNP水平明显下降,大剂量组改善更为显著,2组差异有统计学意义(P<0.05)。结论 rhBNP可以明显改善难治性心力衰竭患者近期心功能状态,缓解患者的症状,表现为尿量增多、LVEF升高,且不同剂量rhBNP对上述指标改善不同,但并不影响心功能的改善程度。

Objective To explore the efficacy of different doses of recombinant human brain natriuretic peptide on patients with refractory heart failure.Methods Eighty patients with refractory heart failure were randomly divided into low-dose group （n=36） and high-dose group （n=44）. Besides traditional heart failure treatment, low-dose group was given continuous intravenous pump of 0.075μg/（kg·min） for 48h, while high-dose group was 0.01μg/（kg·min） for 48h after the first loading dose of 1.5μg/kg intravenous injection. Cardiac function improvement, 24h urine volume, left ventricular ejection fraction （LVEF）, plasma BNP concentration before and after treatment were observed and compared between the two groups. Results The 24h urine volume, LVEF, plasma BNP in both groups improved significantly after treatment and the indexes of high-dose group changed more significantly than those of low-dose group （P〈0.05）. However, there was no significant difference in total effective rate of cardiac function improvement in both groups.Conclusion Different dose of rhBNP could significantly improve urination, LVEF and BNP of RHF sufferers, and high dose has stronger effect. However, different dose have no significant effect on cardiac function improvement.