重组人脑利钠肽联合左西孟坦治疗急性失代偿性心力衰竭的临床观察

Clinical Observation of Recombinant Human Brain Natriuretic Peptide Combined with Levosimendan in the Treatment of Acute Decompensated Heart Failure

目的：观察重组人脑利钠肽（rh BNP）联合左西孟坦治疗急性失代偿性心力衰竭（ADHF）的临床疗效及安全性。方法：采用回顾性研究方法,将120例ADHF患者的临床资料按治疗方案不同分为观察组和对照组,各60例。对照组患者在常规治疗的基础上给予冻干rh BNP,首先以0.15μg/kg的剂量静脉冲击,再以维持剂量0.007 5μg/（kg·min）连续静脉泵注24~72 h;观察组患者在对照组治疗基础上给予负荷剂量12μg/（kg·min）左西孟坦注射液静脉滴注10 min,再以维持剂量0.1μg/（kg·min）静脉泵注24 h,根据患者的临床表现可酌情调整剂量。记录两组患者的生命体征、血流动力学和超声心动图指标、呼吸困难好转率、血浆BNP浓度、尿量及不良反应发生情况。结果：除对照组患者在治疗后1 h的生命体征和血流动力学指标变化不明显外,两组患者治疗后各时间点的心率（HR）、呼吸频率（RR）、收缩压（SBP）、平均肺动脉压（MPAP）和平均肺毛细血管楔压（MPCWP）均明显低于治疗前,血氧饱和度（Sa O2）和心输出量（CO）均明显高于治疗前,差异均有统计学意义（P〈0.05）;观察组患者在治疗后1、2、4 h的HR、RR、SBP、MPAP和MPCWP均明显低于对照组,Sa O2和CO均明显高于对照组,差异均有统计学意义（P〈0.05）,其余各时间点的生命体征和血流动力学指标组间比较,差异无统计学意义（P〉0.05）。治疗后48 h,两组患者的左室射血分数均较治疗前升高,血浆脑利钠肽浓度均较治疗前降低,且观察组患者较对照组改善程度更明显,差异均有统计学意义（P〈0.05）。观察组患者治疗后24、48 h的尿量均明显高于对照组,差异均有统计学意义（P〈0.05）。两组患者治疗后各时间点的呼吸困难好转率及不良反应发生率比较,差异均无统计学意义（P〉0.05）。结论：rh BNP联合左西孟坦能有效改善ADHF患者的生命体征、血流动力学和超声心动图指标及呼吸困难症状,增加尿量,降低血浆BNP浓度,且安全性较高。

OBJECTIVE： To observe the clinical efficacy of recombinant human brain natriuretic peptide （rhBNP） combined with levosimendan in acute decompensated heart failure （ADHF）. METHODS： In retrospective study, 120 cases diagnosed as ADHF were divided into observation group and control group according to treatment plan, with 60 cases in each group. The patients of control group received rhBNP on the basis of conventional treatment, intravenously pulsed with dose of 0.15μg/kg firstly, then maintained dose of 0.007 5μg/kg viacontinuous intravenous pumping for 24-72 h; On the basis of control group, treatment group received levosimendan with loading-dose of 12μg/（kg·min） for 10 min, maintenance dose of 0.1 μg/（kg·min） via intravenous pump, for 24 h, adjusted according to clinical manifestations of patients. The vital signs, hernodynamic and UCG indexes, the rate of dyspnea recovery, plasma level of BNP, urine and the occurrence of ADR were recorded in 2 groups. RESULTS： The vital sign and hemodynamic indexes of control group had no significant change 1 h after treatment; the levels of HR, RR, SBP, MPAP and MPCWP in 2 groups after treatment were significantly lower than before, while the levels of SaO2 and CO were significantly higher than before, with statistical significance （P〈0.05）. The levels of HR, RR, SBP, MPAP and MPCWP in observation group 1, 2, 4 h after treatment were significantly lower than in control group, while the levels of SaO2 and CO were significantly higher than control group, with statistical significance （P〈0.05） ; there was no statistical significance in vital sign and hemodynamic indexes between 2 groups at other time points （P〉0.05）. 48 h after treatment, LVEF of 2 groups were increased while plasma levels of BNP were decreased, compared to before treatment; the improvement of observation group was more significant than control group, with statistical significance （P〈0.05）. And the urine volume of observation group were significantly higher than that of control group 24, 48 h after treatment, with statistical significance （P〈0.05）. There was no statistical significance in the rate of dyspnea recovery at different time points and the incidence of ADR after treatment between 2 groups （P〉0.05）. CONCLUSIONS： rhBNP combined with levosimendan could effectively improve vital sign, hemodynamic indexes, UCG indexes and dyspnea, and decrease the plasma level of BNP with good safety.