重组人脑利钠肽在急性失代偿性心力衰竭患者中的用药合理性分析

Rationality of recombinant human brain natriuretic peptide in treatment of acute decompensated heart failure

目的调查注射用重组人脑利钠肽(rhBNP)在舟山医院急性失代偿性心力衰竭(ADHF)患者中的临床使用情况并分析其合理性。方法收集舟山医院2022年1月至2023年12月诊断为ADHF并接受rhBNP治疗的患者资料,根据药品说明书及最新指南对rhBNP的使用合理性、疗效及药品不良反应(ADR)发生情况进行分析与评价。结果共纳入患者98例,年龄(61.61±6.75)岁,其中,男性60例,女性38例;使用rhBNP注射液单药治疗42例(42.86%),联合用药56例(57.14%)。rhBNP主要用于纽约心脏病协会心功能分级(NYHA)Ⅱ~Ⅳ级的ADHF患者,共80例(81.63%)符合药品说明书中的适应证;rhBNP注射液的用法与用量基本合理,有28例患者(28.57%)的用药疗程<1 d,55例(56.12%)的用药疗程为1~7 d,15例(15.31%)用药疗程>7 d;36例(36.73%)患者存在用药不合理现象。治疗后整体有效率为90.82%,ADR发生率为12.24%;患者的性别、年龄分组间各项数据差异无统计学意义(P>0.05);在肾功能不全的患者中,随着肾功能损害程度的增加,ADR发生率也增加(P<0.05);rhBNP与利尿剂或血管紧张素转化酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB)联合使用时,整体有效率和安全性与单药治疗相似,而当rhBNP与β受体阻滞剂联合使用时,整体有效率较低,且ADR发生率较高(P<0.05)。结论舟山医院rhBNP的使用基本合理,但仍需谨慎对待超适应证用药和过长的用药疗程,临床应用中应全面评估患者病情,制定个性化治疗方案。

Objective To investigate the clinical use of recombinant human brain natriuretic peptide(rhBNP)for injection in treatment of acute decompensated heart failure(ADHF)in Zhoushan Hospital and analyze its rationality.Methods The data of patients diagnosed as suffering from ADHF and received treatment with rhBNP from January 2022 to December 2023 in Zhoushan Hospital were collected.The rationality of rhBNP was analyzed and evaluated according to the drug instructions and the latest guidelines,and the efficacy evaluation and adverse drug reaction(ADR)were observed.Results A total of 98 patients aged(61.61±6.75)years old were included in this study.Of the 98 patients,60 were male and 38 female.Meanwhile,42(42.86%)patients received rhBNP alone and 56(57.14%)underwent combined treatment.rhBNP is mainly used for ADHF patients who were rated as gradeⅡ-Ⅳby the New York Heart Association Heart Function Classification(NYHA).Among 98 patients,80(81.63%)met the indications in the drug instructions.The usage and dosage of rhBNP injection were basically reasonable.Twenty-eight patients(28.57%)had a medication course of less than 1 d,55(56.12%)1 to 7 d and 15(15.31%)over 7 d.Thirty-six patients(36.73%)had unreasonable drug use.The overall efficacy evaluation after treatment was 90.82%and the incidence of ADR was 12.24%.There was no significant difference between gender and age groups(P>0.05).In the patients with renal impairment,the rate of ADR was significantly increased with the severity of the impairment(P<0.05).When rhBNP was used in combination with diuretics or ACEI/ARB,the overall efficacy and safety were similar to those patients receiving rhBNP alone.However,the overall efficacy was low and the incidence of ADR was remarkably high when rhBNP was used in combination withβblockers(P<0.05).Conclusion The application of rhBNP in Zhoushan Hospital is basically reasonable,but it is still necessary to avoid the problems of excessive indications and long treatment courses.In clinical application,a comprehensive evaluation of the patient's condition should be conducted,and personalized treatment plans should be developed.