重组人脑利钠肽治疗急性心梗后失代偿性心力衰竭的疗效观察-东南大学学报医学版

重组人脑利钠肽治疗急性心梗后失代偿性心力衰竭的疗效观察

单位：南京医科大学附属无锡市人民医院心内科,江苏无锡 214023

分类号：R541.4

出版年·卷·期（页码）：2012·31·第一期（93-96）

摘要：

目的:观察重组人脑利钠肽(rhBNP)治疗急性心肌梗死后失代偿性心力衰竭的临床疗效和安全性。方法:选择急性心肌梗死合并失代偿性心力衰竭、心功能Killip Ⅲ级的患者63例,随机分为rhBNP组(32例)和多巴酚丁胺组(31例),在标准抗缺血治疗和静脉用呋塞米针剂抗心衰治疗的基础上,分别加用rhBNP(1.5 μg·kg^-1静脉推注后,以0.007 5~0.01 μg·kg^-1·min^-1,静脉微泵注射72 h)和多巴酚丁胺(2.5~10 μg·kg^-1·min^-1,静脉微泵注射72 h)。在用药前及用药72 h后测定两组患者血脑钠肽(BNP)、左室射血分数(EF)值,重新评价患者心功能Killip分级,观察患者72 h治疗过程中利尿剂用量及血压的变化,并观察30 d内的病死率。结果:两组血BNP均下降,rhBNP组更加明显(P<0.01);与多巴酚丁胺组比较,rhBNP组EF及心功能Killip分级均改善(P<0.01),利尿剂用量减少(P<0.01);两组患者30 d病死率无明显差异(P>0.05)。结论:与多巴酚丁胺比较,rhBNP能更好地改善急性心肌梗死后失代偿性心力衰竭患者的临床症状,但对预后的改善未见明显差异。

Objective: To investigate the efficacy and safety of recombinant human B-type natriuretic peptide(rhBNP) on acute heart failure resulted from acute myocardial infarcfion. Methods: Sixty-three patients with cardiac function KillipⅢ were randomly divided into rhBNP group(n=32) and dobutamine group(n=31). All patients received standard anti-ischemic treatment and anti-heart failure treatment by intravenous injection of furosemide only. rhBNP group was given rhBNP 1.5 μg·kg^-1 bolus injection intravenously, then 0.007 5~0.01 μg·kg^-1·min^-1 for 72 hours.Dobutamine group was given dobutamine 2.5~10 μg·kg^-1·min^-1for 72 hours.The blood BNP, left ventricular ejection fraction(EF%) were determined before treatment and after 72 hours treatment, cardiac function of the patients were re-evaluation by Killip classification. The amount of diuretics, blood pressure, and 30 days mortality were observed. Results: Compared with dobutamine group, blood BNP was significantly decreased in the rhBNP group(P<0.01), EF and Killip classification of cardiac function improved significantly(all P<0.01), the amount of diuretics was reduced(P<0.01). No significant difference was found in 30-day mortality between the two groups(P>0.05). Conclusion: Compared with dobutamine, rhBNP is better in improve heart function of patients with acute decompensated heart failure resulted from acute myocardial infarction, but there is no difference in prognosis between them.

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