目的 探讨冻干重组人脑钠肽(rhBNP)对慢性充血性心力衰竭失代偿病人血浆N末端人脑钠肽前体(NT-proBNP)和左心室收缩期射血分数(LVEF)的影响,并判断其临床疗效及安全性.方法 入选慢性充血性心衰失代偿住院病人80例,分为治疗组和对照组,其中对照组38例,治疗组42例,对照组给予心力衰竭标准化治疗;治疗组则在常规的心衰标准化治疗的基础上加用小剂量冻干重组人脑钠肽静脉应用7 d,观察两组在治疗前后的NT-proBNP、LVEF、肺动脉压力(SPAP)、左心室舒张末内径(LVEDd)、血肌酐、血K+、血Na+、24 h尿量及临床症状的变化.结果 与对照组比较,治疗组纽约心功能分级改善、LVEF升高、NT-proBNP下降及尿量增加更明显,差异有统计学意义(P<0.05).两组病人治疗前后血肌酐、血K+、血Na+差异无统计学意义(P>0.05).结论 小剂量冻干重组人脑钠肽在标准化心力衰竭治疗的基础上可进一步提高LVEF,降低血浆NT-proBNP,增加尿量,改善病人心功能分级,其临床疗效显著,安全性好.%Objective To discuss the variation of plasma NT-proBNP and LVEF of patients with chronic decompensated congestive heart failure who accepted rhBNP (recombinant human brain natriuretic peptide) therapy,and determine its efficacy and safety.Method 80 cases of hospitalized patients with chronic decompensated congestive heart failure were divided into two groups,38 cases in the control group and 42 cases in the therapeutic group.The two groups were applied intravenous administration of conventional standardized treatment for heart failure.We gave small doses of rhBNP for 7 days additionally with the therapeutic group.The NT-proBNP,LVEF,SPAP,LVEF and NYHA grade before the treatment and two weeks after the treatment,as well as the variation of biochemical indicators including creatinine,kalium and sodium,24 hour urine and clinical symptoms of both groups of patients before and after the treatment were observed.Results Compared with control group,the therapeutic group can improve cardiac function classification of New YorkHeart Association (NYHA),the LVEF,24 hour urine volume and decrease the NT-proBNP more obviously.The difference was statistically significant (P<0.05).There was no significant difference in two groups of patients before and after treatment in serum creatinine,potassium ion,sodium ion (P>0.05).Conclusion Based on traditional treatment of cardiac failure,small doses of rhBNP can significantly reduce plasma NT-proBNP,enhance LVEF,increase urine volume and improve patients' NYHA grading.It presents good clinical efficacy and high security.
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