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|本期目录/Table of Contents|

重组人脑钠尿肽对失代偿性心力衰竭患者的疗效(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第4期
页码:
449-452
栏目:
临床研究
出版日期:
2008-08-20

文章信息/Info

Title:
Observation of therapeutic effect of recombinant human brain natriuretic peptide on decompensated heart failure
作者:
谢昌联; 孟素荣; 王蔚; 陈少敏; 李鹏; 冯旭光
南方医科大学南方医院心内科，广东 广州 510515
Author(s):
XIE Changlian;  MENG Surong;  WANG Wei;  CHEN Shaomin;  LI Peng;  FENG Xuguang
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, China
关键词:
脑钠尿肽; 重组人; 心力衰竭; 失代偿性; 疗效
Keywords:
Recombinant human brain natriuretic peptide;  heart failure;  decompensated;  therapeutic effect
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的 观察静脉用重组人脑钠尿肽（rhBNP）对失代偿性心力衰竭患者的临床疗效。方法 我院50例急性失代偿性心力衰竭住院患者随机分为硝普钠组和rhBNP组,分别记录两组患者给药前及给药后0.5 h、6 h及24 h的呼吸困难程度以及整体临床情况，以及用药24 h后液体的出入量和血流动力学参数。其中硝普钠组使用硝普钠（起始10 μg/min，根据血压每10 min增加5 μg/min，维持在50～100 μg/min），rhBNP组使用rhBNP\[首先以15 μg/kg 弹丸式静脉冲击,随后以0.0075 μg/(kg·min)连续静脉滴注24 h\]。结果 静脉给药05 h后rhBNP与硝普钠改善呼吸困难和整体临床状况的程度未见明显差异,6 h及24 h后rhBNP组患者的呼吸困难好转程度和整体临床状况好转程度显著优于硝普钠组（P<0.05）；用药24 h后rhBNP组的尿量（2 014±243）ml明显多于硝普钠组（1 341±240）ml（P<0.05）；用药24 h时rhBNP与硝普钠同样能明显增加患者的左室射血分数，以及明显降低肺动脉压和收缩压，但无统计学差异。结论 rhBNP能明显改善急性失代偿性心力衰竭患者呼吸困难及整体临床状况。
Abstract:
AIM To observe the effectiveness of intravenous recombinant human brain natriuretic peptide (rhBNP) in the treatment of decompensated heart failure. METHODS Fifty cases of decompensated heart failure patients were randomly divided into rhBNP group and the nitroprusside sodium group. In all the patients, dyspnea and global clinical status were assessed at 05 hours, 6 hours and 24 hours after administration and the input liquid and urine and homodynamic parameters were recorded 24 hours after administration. The nitroprusside sodium group used nitroprusside sodium with initial 10 μ g per minute, increase of 5 μg per minute every 10 minutes based on blood pressure, maintaining at 50-100 μg per minute. The rhBNP group used rhBNP with initial 1.5 μg per kilogram of body weight bolus intravenous, followed by an infusion of 00075 μg per kilogram of body weight per minute for 24 hours. RESULTS The difference of the improved level of dyspnea and global clinical status between the rhBNP group and the nitroprusside sodium group were not significant at 05 h, but significant difference of both were observed at 6 hours and 24 hours after administration (P<005). After 24 hours of treatment, the urine of the rhBNP group（2 014±243 ml）was significantly higher than that of the nitroprusside sodium group（1 341±240 ml）（P<005）while the difference in reduction of pulmonary artery pressure and systolic blood pressure and the increase in ejection fraction of the rhBNP group was not significant compared with that of the nitroprusside sodium group. CONCLUSION rhBNP promotes the excretion of urine, decreases pulmonary artery pressure and increases left ventricular ejection fraction. rhBNP significantly improves dyspnea and global clinical status of patients with decompensated heart failure.

参考文献/References

［1］ de Denus S, Pharand C, Williamson DR. Brain natriuretic peptide in the management of heart failure: the versatile neurohormone［J］. Chest, 2004, 125(2):652-668.

［2］ Publication Committee for the VMAC Investigators. Intravenous nesiritide and nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial ［J］. JAMA, 2002, 287(12):1531-1540.

［3］ Burger AJ. A review of the renal and neurohormonal effects of Btype natriuretic peptide［J］. Congest Heart Fail, 2005, 11(1):30-38.

［4］ Kapoun AM, Liang F, O’Young G, et al. Btype natriuretic peptide exerts broad functional opposition to transforming growth factorbeta in primary human cardiac fibroblasts: fibrosis, myofibroblast conversion, proliferation, and inflammation［J］. Circ Res, 2004, 94(4):453-461.

［5］ Witteles RM, Kao D, Christopherson D, et al. Impact of nesiritide on renal function in patients with acute decompensated heart failure and preexisting renal dysfunction a randomized, doubleblind, nitroprusside sodiumcontrolled clinical trial［J］. J Am Coll Cardiol, 2007, 50(19):1835-1840.

［6］ SacknerBernstein JD, Skopicki HA, Aaronson KD. Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure［J］. Circulation, 2005, 111(12):1487-1491.

［7］ Arora S, Clarke K, Srinivasan V, et al. Effect of nesiritide on renal function in patients admitted for decompensated heart failure［J］. QJM, 2007, 100(11):699-706.

备注/Memo

备注/Memo:
收稿日期：2007-11-23. 基金项目：广东省科技计划项目资助（73011） 通讯作者：孟素荣，教授，主要从事心脏起搏与心电生理的研究Email:enirehtac@163.com 作者简介：谢昌联，硕士生Email:xeinthoven@gmail.com
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