CAJ | 학술논문

目的观察国产冻干重组人脑利钠肽(rhBNP)治疗难治性冠心病心力衰竭的临床疗效.方法入选7例难治性冠心病心力衰竭患者在常规治疗基础上,予国产冻干rhBNP,同时停用其他静脉扩血管药物.rhBNP冲击量以1.5 μg/kg在60～90 s匀速静脉注射,继以0.0075～0.01 μg/(kg·min)持续静脉注射48～72 h.分别在给药0、15、30 min和1、2、4、8、12、24、48 h记录呼吸困难程度、尿量、全身临床状况、心率及血压,并测量中心静脉压,测定治疗前后血钾、血钠、血肌酐、血浆BNP.结果经国产冻干rhBNP治疗,7例患者中按呼吸困难程度评估5例好转,按临床状况评估6例好转.治疗15 min时收缩压较治疗前有所下降[(105.14±7.76)比(112.00±10.42)mm Hg,P＜0.05],30 min后收缩压为(108.71±6.63)mm Hg恢复至治疗前水平.治疗前后心率[(88.57±16.92)比(86.00±16.21)次/min]、血钠[(133.57±5.38)比(133.57±8.16)mmol/L]、血钾[(3.83±0.37)比(4.19±0.58)mmol/L]、血肌酐[(93.11±27.90)比(123.01±93.01)μmol/L]及治疗前与治疗24 h时血浆BNP[(1218.43±847.83)比(1433.71±676.08)ns/L]比较差异均无统计学意义(P均＞0.05).治疗前后尿量比较差异无统计学意义[(2329±1573)比(2126±1074)ml,P＞0.05],但利尿剂用量明显减少.中心静脉压于治疗30 min～48 h均较前逐渐下降(P均＜0.05).结论国产冻干rhBNP治疗难治性冠心病心力衰竭有较好的临床疗效,能有效降低中心静脉压,增加尿量,而对电解质及肾功能没有明显影响.
목적 관찰국산동간중조인뇌리납태(rhBNP)치료난치성관심병심력쇠갈적림상료효.방법 입선7례난치성관심병심력쇠갈환자재상규치료기출상,여국산동간rhBNP,동시정용기타정맥확혈관약물.rhBNP충격량이1.5 μg/kg재60～90 s균속정맥주사,계이0.0075～0.01 μg/(kg·min)지속정맥주사48～72 h.분별재급약0、15、30 min화1、2、4、8、12、24、48 h기록호흡곤난정도、뇨량、전신림상상황、심솔급혈압,병측량중심정맥압,측정치료전후혈갑、혈납、혈기항、혈장BNP.결과 경국산동간rhBNP치료,7례환자중안호흡곤난정도평고5례호전,안림상상황평고6례호전.치료15 min시수축압교치료전유소하강[(105.14±7.76)비(112.00±10.42)mm Hg,P＜0.05],30 min후수축압위(108.71±6.63)mm Hg회복지치료전수평.치료전후심솔[(88.57±16.92)비(86.00±16.21)차/min]、혈납[(133.57±5.38)비(133.57±8.16)mmol/L]、혈갑[(3.83±0.37)비(4.19±0.58)mmol/L]、혈기항[(93.11±27.90)비(123.01±93.01)μmol/L]급치료전여치료24 h시혈장BNP[(1218.43±847.83)비(1433.71±676.08)ns/L]비교차이균무통계학의의(P균＞0.05).치료전후뇨량비교차이무통계학의의[(2329±1573)비(2126±1074)ml,P＞0.05],단이뇨제용량명현감소.중심정맥압우치료30 min～48 h균교전축점하강(P균＜0.05).결론 국산동간rhBNP치료난치성관심병심력쇠갈유교호적림상료효,능유효강저중심정맥압,증가뇨량,이대전해질급신공능몰유명현영향.
Objective To examine the clinical effects of intravenous lyophilize recombinant human brain natriuretic peptide (rhBNP) in patients with refractory heart failure caused by coronary artery disease.Methods Seven patients with refractory heart failure caused by coronary artery disease were treated with rhBNP.The rhBNP nea grade,symptoms and signs,24 hours urine output,heart rate,blood pressure and central venous pressure were evaluated at 0,15,30 min and 1,2,4,8,12,24,and 48 h.Serum potassium,sodium,creatinine and plasma BNP before and after treatment were measured.Results After rhBNP therapy,dyspnea grade were improved in 5 patients.Symptoms and signs got better in 6 patients.Systolic blood pressure at 15 min of treatment distolic blood pressure was decreased slightly from (112.00±10.42) mm Hg to (105.14±7.76) mm Hg (P＜0.05) and became (108.71±6.63)mm Hg at 30 rain which was the same with that before treatment.There was no statistical significance in heart beat[ ( 88.57±16.92 ) vs.( 86.00±16.21 ) ] beat/min,serum sodium [ ( 133.57±5,38 ) mmol/Lvs.( 133.57±8.16) mmol/L ],serum potassium [ (3.83±0.37) mmol/L vs.(4.19±0.58 ) mmol/L ],ereatinine [ (93.11±27.90) μmol/L vs ( 123.01±93.01 ) μmol/L ] before and after treatment,and BNP[ ( 1218.43±847.83) vs.(1433.71±676.08)ng/L] before treatment and at24 h treatment,as well as urine output [(2329±1573 ) vs.(2126±1074) ml ] ( P ＞ 0.05 ).Urine output was increased during the treatment,but the usage of diuretic was remarkably decreased.Central venous pressure was gradually decreased from 30 rain to 48 h( P ＜ 0.05 ).Condusion rhBNP can decrease central venous pressure and increase urine output with exerts little side effects on electrolytes and renal function.Therefore rhBNP has positive clinical effects on refractory heart failure which is caused by coronary artery disease.