冻干重组人脑钠肽与硝普钠治疗慢性心力衰竭急性发作合并Ⅰ型呼吸衰竭的比较  

Comparison of lyophilized recombinant human brain natriuretic peptide and sodium nitroprusside in treating acute decompensation of chronic heart failure combined with type I respiratory failure

作　　者：曾国良[1] 黄兴福[2] 何利伟[2] 彭健[2] 

机构地区：[1]肇庆市第一人民医院心内科,广东肇庆526000 [2]南方医科大学南方医院心血管内科,广州510515

出　　处：《岭南心血管病杂志》2016年第3期308-311,共4页South China Journal of Cardiovascular Diseases

基　　金：广州市科技计划项目资助(项目编号:201300000146)

摘　　要：目的比较冻干重组人脑钠肽（lyophilized recombinant human brain natriuretic peptide,lrhBNP;新活素）与硝普钠治疗慢性心力衰竭（chronic heart failure,CHF）急性发作合并Ⅰ型呼吸衰竭（呼衰）的疗效及安全性。方法选取2010年9月至2012年6月在南方医院心内科住院87例（男46例,女41例,年龄32~79岁）CHF急性发作患者,按随机数字表法随机分为两组,对照组在常规强心、利尿、扩血管等治疗基础上加用硝普钠,实验组在常规治疗基础上加用lrhBNP。一级终点：总有效率、不良反应发生率。二级终点：有效患者症状缓解时间、血浆脑钠肽（brain natriuretic peptide,BNP）浓度下降速度。比较两组间疗效及安全性。结果对于CHF急性发作合并Ⅰ型呼衰,相对于硝普钠,lrhBNP有效率更高[62.8%（27/43）vs.59.4%（38/44）,P〈0.05],其中显效部分尤为突出[25.6%（11/43）vs.11.4%（5/44）,P〈0.05],症状缓解更迅速[（5.6±1.5）d vs.（7.0±2.1）d,P〈0.05]。两组血浆BNP浓度下降时间[（4.1±1.6）d vs.（4.7±1.3）d,P〉0.05]、不良事件发生率[11.6%（5/43）vs.5.2.3%（1/44）,P=0.11]比较,差异无统计学意义。结论对于CHF急性发作合并Ⅰ型呼衰,lrhBNP治疗效果优于硝普钠。Objectives To compare the efficacy and safety of lyophilized recombinant human brain natriuretic peptide （lrhBNP） and sodium nitroprusside in treating acute decompensation of chronic heart failure （CHF） combined with type I respiratory failure. Methods Eighty-seven consecutive patients （male： 46, female： 41, age： 32-79 years） diagnosed as acute decompensation of CHF combined with type I respiratory failure in Nanfang Hospital from September 2010 to June 2012 were prospectively assigned in a random fashion to two groups. Control group （n=43） was treated with intravenous sodium nitroprusside on basic medicine, while treatment group （n=44） was treated with lrhBNP on basic medicine. Primary endpoints： total effective rate, adverse event rate. Secondary endpoints： mean time to remission, reduction time of plasma concentration of brain natriuretic peptide （BNP）. Efficacy and safety were compared between the two groups. Results Total effective rate was significant higher in treatment group [62.8% （27/43） vs. 59.4% （38/44）, P〈0.051, the difference was more obvious when concerning the excellent part [ 25.6% （11/43） vs. 11.4% （5/44）, P〈0.05 ]. Mean time to remission was significantly shorter in treatment group than in control group [ （5.6±1.5） d vs. （7.0±2.1） d, P〈O.05]. Adverse event rate and reduction time of plasma concentration of BNP were similar between the two groups [11.6% （5/43） vs. 2.3% （1/44）, P=0.11; （4.1±1.6） d vs. （4.7±1.3） d, P〉O.05]. Conclusions LrhBNP is superior to sodium nitroprusside in treating acute decompensation of CHF combined with type I respiratory failure.

关 键 词：心力衰竭 冻干重组人脑钠肽 硝普钠 Ⅰ型呼吸衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]