重组人脑利钠肽治疗急性失代偿性心力衰竭的疗效观察

Clinical Efficacy Observation of Recombinant Human Brain Natriuretic Peptide in the Treatment of Acute Decompensated Heart Failure

目的观察重组人脑利钠肽(rhBNP)治疗急性失代偿性心力衰竭(ADHF)的疗效。方法选取重庆市开州区人民医院收治的ADHF病人80例,随机分为对照组和干预组,各40例。对照组静脉输注硝酸甘油,先以5μg/min给予静脉输注,然后根据血压情况递增至20μg/min,持续72 h进行常规抗心力衰竭治疗。干预组在常规治疗的基础上给予rhBNP治疗,先以1.5μg/kg静脉推注,然后维持剂量0.0075μg/(kg·min),连续应用72 h。比较两组治疗前和治疗3 d后左心室射血分数、中心静脉压、每日出入量,托拉塞米和多巴胺的总用量,临床疗效情况,并对两组病人进行安全性分析。结果治疗前,两组左心室射血分数(LVEF)及中心静脉压(CVP)比较差异均无统计学意义(P>0.05)。治疗后,干预组LVEF高于对照组[(40.24±4.63)%与(36.33±5.45)%,P<0.01],CVP低于对照组[(8.12±0.86)cmH2O与(10.31±1.54)cmH2O,P<0.01]。治疗前,两组每日平均入量和每日平均尿量比较差异均无统计学意义(P>0.05);治疗后,干预组每日平均尿量[(1982±435)mL]明显高于对照组[(1586±246)mL],托拉塞米和多巴胺用量明显低于对照组,差异均有统计学意义(P<0.01)。治疗后,干预组治疗总有效率为95.0%,高于对照组的85.0%,但差异无统计学意义(P>0.05)。结论采用rhBNP治疗ADHF能够改善左心室射血分数、中心静脉压,控制病人出入量,减少利尿药物的使用。

Objective To investigate the efficacy of recombinant human brain natriuretic peptide(rhBNP)in the treatment of acute decompensated heart failure(ADHF).Methods Eighty cases of rHBNP patients were randomly divided into control group and intervention group,with 40 cases in each group.The patients in control group were given intravenous infusion of nitroglyceri 5μg/min,and then increasing to 20μg/min for 72 hours.The patients in intervention group were given intravenous injection of rhBNP on the basis of conventional treatment,first infusion of 1.5μg/kg,followed by maintenance dose of 0.0075μg/(kg·min),continuous application for 72 h.The left ventricular ejection fraction,central venous pressure,average daily urine volume,the total dose of torasemide and dopamine,curative effect,and safety were compared between two groups before treatment and after 3 days of treatment.Results Before treatment,there were no significant differences in left ventricular ejection fraction and central venous pressure between control group and intervention group(P>0.05).After treatment,the left ventricular ejection fraction in the intervention group was significantly higher than that in the control group[(40.24±4.63)%vs(36.33±5.45)%,P<0.01],and the central venous pressure was significantly lower than that in the control group[(8.12±0.86)cmH2O vs(10.31±1.54)cmH2O,P<0.01].Before treatment,there was no significant difference in the average daily intake and the average daily urine volume between intervention group and control group(P>0.05).After treatment,the average daily urine volume in intervention group was significantly more than that of the control group[(1982±435)mL vs(1586±246)mL];the doses of torasemide and dopamine in intervention group were lower than that in control group(P<0.01).After treatment,the total effective rate in intervention group was significantly higher than that of control group(95.0%vs 85.0%,P>0.05).Conclusion rhBNP can improve the left ventricular ejection fraction and central venous pressure,control the fluid input and output,and reduce the use of diuretic drugs.