静脉给予两次低剂量重组人脑利钠肽治疗顽固性心衰的疗效及安全性  

Efficacy and safety of two intravenous medications of low-dose recombinant human brain natriuretic peptide in patients with refractory heart failure

作　　者：杜贺[1] 唐念中[1] 陈少萍[1] 

机构地区：[1]第二军医大学长海医院心血管内科,上海200433

出　　处：《药学服务与研究》2015年第2期115-118,共4页Pharmaceutical Care and Research

摘　　要：目的:观察冻干重组人脑利钠肽(新活素,recombinant human brain natriuretic peptide,rhBNP)治疗顽固性心衰(refractory heart failure,RHF)的疗效与安全性。方法:2013年2月至2014年5月第二军医大学长海医院心血管内科收治的RHF病人78例,随机分为对照组和rhBNP组,每组39例。在常规抗心衰治疗的基础上,rhBNP组给予rhBNP治疗,先在10min内匀速静脉注射负荷剂量1.5μg/kg,随后以0.01μg·kg-1·min-1维持静脉泵入(至少10h泵入),每次总量0.5mg,隔3d再重复给药1次。第2次用药后7d,比较两组病人的心功能分级、脑利钠肽(BNP)和肌酐水平、左室射血分数(LVEF)、左室舒张末内径(LVEDD),并记录不良反应。结果:rhBNP组心功能改善36例,总有效率为92.31%,显著高于对照组的28例(71.79%,P<0.05)。两组病人用药后心率减慢,舒张压、肌酐和BNP降低,LVEF提高,LVEDD减小,与用药前比较差异有极显著意义(P<0.001),且rhBNP组心率、舒张压、LVEDD、血肌酐和BNP水平的降低,和LVEF的提高比对照组更明显(P<0.001)。rhBNP组发生1例低血压和1例低血钾,对照组发生2例低血压和1例室性心律失常,两者不良事件无显著差异(P>0.05)。结论:在常规抗心衰治疗基础上再静脉给予两次rhBNP(间隔3d),可以进一步改善RHF病人的心功能和血流动力学,降低血浆BNP和血清肌酐水平,使疗效提高,但并不增加不良反应。Objective：To observe the efficacy and safety of two intravenous medications of low-dose recombinant human brain natriuretic peptide（rhBNP）in patients with refractory heart failure（RHF）.Methods：Seventy-eight patients with RHF admitted into the Department of Cardiovasology of Changhai Hospital,Second Military Medical University from February,2013 to May,2014 were randomly divided into the control and the rhBNP groups,each consisting of 39 patients.On the basis of routine drug treatment of heart failure,rhBNP was given to the patients in the rhBNP group.Intravenous rhBNP at a loading dose of 1.5μg/kg was given uniformly within 10 min,then,continuous infusion of rhBNP at a rate of 0.01μg·kg-1·min-1 was pumped in over 10 hours,with a total amount of 0.5mg.On day 4,another dose of 0.5mg rhBNP was given in the same way.After 7days of the second medication,the cardiac function,levels of plasma brain natriuretic peptide（BNP）and serum creatinine,left ventricular ejection fraction（LVEF）,left ventricular end-diastolic diameter（LVEDD）and the adverse reactions were compared between the 2groups.Results：For the rhBNP group,cardiac function of the 36 patients was improved,with a total effective rate of 92.31%,which was significantly higher,as compared with 71.79% of the control group（28 patients）（P〈0.05）.Heart rate（HR）,diastolic blood pressure（DBP）,levels of plasma BNP and serum creatinine,and LVEDD were all significantly decreased,and the level of LVEF was increased for the patients of both groups,following medication.Significant differences could be noted,as compared with the data before medication（P〈0.001）.HR,DBP,levels of LVEDD,serum creatinine and plasma BNP were all decreased,while the level of LVEF was increased for the patients of the rhBNP group,which were significantly higher than those of the control group（P〈0.001）.One case of hypotension and one case of hypopotassemia were observed in the rhBNP group,and 2cases of hypotension and one case of ventricular arrhy

关 键 词：心力衰竭 重组人脑利钠肽 药物疗法 安全性 

分 类 号：R541.61[医药卫生—心血管疾病]