冻干重组人脑利钠肽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 on Acute Decompensated Heart Failure

目的：观察冻干重组人脑利钠肽（rh BNP）治疗急性失代偿性心力衰竭（ADHF）的疗效和安全性。方法：选取2013年7月-2015年7月我院收治的ADHF患者129例,按照随机数字数字表法分为观察组（69例）和对照组（60例）。对照组患者给予常规治疗,观察组患者在对照组基础上给予注射用rh BNP 1.5μg/（kg·d）静脉冲击（d1）,之后给予注射用rh BNP 1 mg＋5%葡萄糖注射液100 ml以0.007 5μg/（kg·min）的速度ivgtt（d2~4）。两组患者疗程均为7 d。观察两组患者临床疗效、心功能指标[左室射血分数（LVEF）、左室舒张末期内径（LVDd）]、给药24 h后生物标志物N-末端脑钠肽原（NT-pro BNP）水平、液体摄入量和尿量,并观察不良反应发生情况。结果：观察组脱落3例,最终入组66例。观察组患者ADHF治疗总有效率（96.97%）明显高于对照组（86.67%）,差异有统计学意义（P〈0.05）。治疗前,两组患者LVEF、LVDd和NT-pro BNP水平比较,差异无统计学意义（P〉0.05）。治疗后,两组患者LVEF水平明显升高,LVDd水平明显降低,且观察组患者LVEF水平[（42.3±3.6）%]明显高于对照组[（37.9±3.3）%],观察组患者LVDd[（55.5±3.6）%]明显低于对照组[（61.3±3.4）%];两组患者NT-pro BNP水平明显降低,且观察组患者[（1 389.5±29.6）pg/ml]明显低于对照组[（2 778.0±26.8）pg/ml];用药24 h后,两组患者的尿量均明显高于液体摄入量,且观察组患者的尿量[（1 781.4±89.7）ml]明显高于对照组[（1 372.6±78.3）ml],差异均有统计学意义（P〈0.05）。观察组患者（3.03%）与对照组（5.00%）的不良反应发生率比较,差异无统计学意义（P〉0.05）。结论：rh BNP治疗ADHF具有较好的临床疗效,可促进患者心功能恢复,减少肾脏功能损害的发生,安全性较高。

OBJECTIVE： To observe therapeutic efficacy and safety of recombinant human brain natriuretic peptide （rhBNP） in the treatment of acute decompensated heart failure （ADHF）. METHODS： 129 ADHF patients admitted in our hospital during Jul. 2013-Jul. 2015 were randomly divided into observation group （69 cases） and control group （60 cases）. Control group was given routine treatment. Observation group was additionally given rhBNP 1.5μg/（kg, d）vein shock （dl）, and then rhBNP 1 mg＋5% Glucose injection 100 ml by 0.007 5μg/（kg.min）, ivgtt （d2-4）. Treatment courses of 2 groups lasted for 7 d. Therapeutic efficacy and heart function indexes [left ventricular ejection fraction （LVEF）, left ventricular end-diastolic diameter （LVDd）] were observed in 2 groups as well as NT-proBNP level, medication fluid intake and urine volume 24 h after medication. The occurrence of ADR was observed. RESULTS： 3 cases dropped out and 66 cases were included finally in doservation group. Total effective rate of ADHF therapy in observation group （96.97%） was significantly higher than in control group （86.67%）, with statistical significance （P〈0.05）. There was no statistical significance in LVEF,LVDd and NT-proBNP between 2 groups before treatment （P〉0.05）. After treatment, LVEF of 2 groups were increased significantly while LVDd were decreased significantly; LVEF of observation group [（42.3 ± 3.6）%] was significantly higher than in control group[（37.9 ± 3.3）%],while LVDd of observation group [（55.5 ± 3.6） %] was significantly lower than in control group[（61.3 ± 3.4）%]. NT-proBNP levels of 2 groups were decreased significantly, and the observation group [（1 389.5 ± 29.6）pg/ml] was significantly lower than the control group [（2 778.0 ±26.8）pg/ml]. 24 h after medication, urine volume of 2 groups were significantly higher than medication fluid intake, and urine volume of observation group [（1 781.4 ± 89.7）ml] was significantly higher than that of control group [（1 372.6 ± 78.3）ml], with statistical significance （P〈0.05）. There was no statistical significance in the incidence of ADR between observation group （3.03%） and control group （5.00%）, without statistical significance （P〉0.05）. CONCLUSIONS： rhBNP is significantly effective for ADHF, promotes heart function recovery and reduces renal function injury with good safety.