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目的:探讨国产重组人脑利钠肽(rhBNP)治疗急性失代偿性心力衰竭的疗效及安全性。方法:收集2005年1月至2006年3月,住院用rhBNP治疗的15例急性失代偿性心力衰竭患者的临床资料。用药方法为:先给予rhBNP1.5μg/kg负荷剂量,于1～3min内静脉推注,继以0.0075μg/(kg.min)的速率维持泵入25.9～46h,用药总剂量1.0mg。回顾性比较患者用药前后,BP、HR、R、尿量、血清肌酐(SCr)、BNP和左心室射血分数(LVEF)的变化,分析rhBNP的疗效及安全性。结果:结束用药时15例患者的呼吸困难均有不同程度缓解,呼吸由(35.2±6.1)次/min降低至(24.4±5.0)次/min,但P>0.05;尿量由(1452.7±1611.9)ml/d增加至(2149.4±1279.6)ml/d,呋塞米用量由(86.0±77.2)mg/d减少至(40.0±28.2)mg/d,HR由(97.4±29.9)次/min减慢为(79.8±15.0)次/min(均P<0.05)。停药24h,上述症状进一步改善(均P<0.05)。2例患者使用rhBNP后室性心律失常明显减少。患者血压轻度下降,但用药前后的差异无统计学意义(P>0.05),SCr、BNP、LVEF亦无明显变化。3例患者住院期间死亡(2例死于多脏器衰竭,1例死于心室颤动);8～32周随防期间11例存活,1例死亡(死于消化道出血)。结论:国产rhBNP能迅速缓解急性失代偿性心力衰竭的临床症状,患者耐受性良好,可用作心力衰竭急性期的治疗。
Objective: To investigate the efficacy and safety of domestic recombinant human brain natriuretic peptide (rhBNP) in the treatment of acute decompensated heart failure. Methods: The clinical data of 15 patients with acute decompensated heart failure treated with rhBNP in hospital from January 2005 to March 2006 were collected. Method of administration was as follows: First, rhBNP 1.5μg / kg loading dose was given intravenously within 1 ~ 3min, followed by parenteral administration of 0.0075μg / (kg · min) for 25.9 ~ 46h with total dosage of 1.0mg. The changes of BP, HR, R, urine volume, serum creatinine (SCr), BNP and left ventricular ejection fraction (LVEF) before and after treatment were retrospectively analyzed. The efficacy and safety of rhBNP were analyzed. Results: The respiratory dysfunction was relieved in 15 patients at the end of treatment, and the respiratory rate decreased from (35.2 ± 6.1) times / min to (24.4 ± 5.0) times / min, but P> 0.05. The urine output increased from (1452.7 ± 1611.9) d and furosemide decreased from (86.0 ± 77.2) mg / d to (40.0 ± 28.2) mg / d, HR decreased from (97.4 ± 29.9) min / min to (2149.4 ± 1279.6) ml / Slow (79.8 ± 15.0) times / min (all P <0.05). 24h withdrawal, the above symptoms further improved (all P <0.05). Ventricular arrhythmias were significantly reduced in 2 patients after rhBNP administration. Patients’ blood pressure decreased slightly, but there was no significant difference before and after treatment (P> 0.05). There was no significant change in SCr, BNP and LVEF. Three patients died during hospitalization (2 died of multiple organ failure and 1 died of ventricular fibrillation). Eleven survived and died of gastrointestinal bleeding in 8 to 32 weeks. Conclusion: Domestic rhBNP can quickly relieve the clinical symptoms of acute decompensated heart failure, patients with good tolerance, can be used as the treatment of acute phase of heart failure.