中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
11期
1151-1153
,共3页
重组人脑利钠肽%心力衰竭%血液动力学
重組人腦利鈉肽%心力衰竭%血液動力學
중조인뇌리납태%심력쇠갈%혈액동역학
Recombinant human brain natriuretic peptide%Heart failure%Hemodynamics
目的 研究重组人脑利钠肽(rhBNP)治疗顽固性心力衰竭(RHF)患者血液动力学效应及安全性.方法 选择住院期间经常规抗心力衰竭药物强化治疗无明显改善的RHF患者16例,给予rhBNP 1.5 μg/kg静脉冲击后,以0.007 5μg/(kg·min)连续静脉滴注24h.在给药后24h内监测有创血液动力学参数、血压、心率及血清生化指标,应用rhBND 3 d后,行超声心动图检测心脏指数(CI)、左心室舒张末期容积(LEVDD)、左心室射血分数(LVEF).结果 在注射rhBNP 15 min时肺毛细血管楔压[PCWP(22.7±4.0)mm Hg与(25.3±3.9)mm Hg]、平均肺动脉压[MPAP(31.9±3.6)mm Hg与(34.6±7.8)mm Hg]较基础值明显下降(P＜0.05);收缩压在给药后1h下降[(105.2±11.5)mm Hg与(119.0±17.2)mm Hg],差异有统计学意义(P均＜0.01),以后逐渐恢复至基线时水平;用药24h心率也明显改善[(109.0±10.8)次/min与(82.2±8.6)次/min](P ＜0.01);血钾、血钠、血肌酐无明显变化;用药3d后CI[(3.7±0.6)L/m2与(1.8±0.4)L/m2]和EF[(43.1±8.3)％与(31.2±6.4)％]均有明显改善,LVEDD明显缩小[(63.6±5.7)mm与(67.3±6.2)mm](P均＜0.01).未发生与rhBNP相关的症状性低血压及其他严重不良反应.结论 静脉应用rhBNP能迅速改善RHF患者血液动力学状况,且安全可行.
目的 研究重組人腦利鈉肽(rhBNP)治療頑固性心力衰竭(RHF)患者血液動力學效應及安全性.方法 選擇住院期間經常規抗心力衰竭藥物彊化治療無明顯改善的RHF患者16例,給予rhBNP 1.5 μg/kg靜脈遲擊後,以0.007 5μg/(kg·min)連續靜脈滴註24h.在給藥後24h內鑑測有創血液動力學參數、血壓、心率及血清生化指標,應用rhBND 3 d後,行超聲心動圖檢測心髒指數(CI)、左心室舒張末期容積(LEVDD)、左心室射血分數(LVEF).結果 在註射rhBNP 15 min時肺毛細血管楔壓[PCWP(22.7±4.0)mm Hg與(25.3±3.9)mm Hg]、平均肺動脈壓[MPAP(31.9±3.6)mm Hg與(34.6±7.8)mm Hg]較基礎值明顯下降(P＜0.05);收縮壓在給藥後1h下降[(105.2±11.5)mm Hg與(119.0±17.2)mm Hg],差異有統計學意義(P均＜0.01),以後逐漸恢複至基線時水平;用藥24h心率也明顯改善[(109.0±10.8)次/min與(82.2±8.6)次/min](P ＜0.01);血鉀、血鈉、血肌酐無明顯變化;用藥3d後CI[(3.7±0.6)L/m2與(1.8±0.4)L/m2]和EF[(43.1±8.3)％與(31.2±6.4)％]均有明顯改善,LVEDD明顯縮小[(63.6±5.7)mm與(67.3±6.2)mm](P均＜0.01).未髮生與rhBNP相關的癥狀性低血壓及其他嚴重不良反應.結論 靜脈應用rhBNP能迅速改善RHF患者血液動力學狀況,且安全可行.
목적 연구중조인뇌리납태(rhBNP)치료완고성심력쇠갈(RHF)환자혈액동역학효응급안전성.방법 선택주원기간경상규항심력쇠갈약물강화치료무명현개선적RHF환자16례,급여rhBNP 1.5 μg/kg정맥충격후,이0.007 5μg/(kg·min)련속정맥적주24h.재급약후24h내감측유창혈액동역학삼수、혈압、심솔급혈청생화지표,응용rhBND 3 d후,행초성심동도검측심장지수(CI)、좌심실서장말기용적(LEVDD)、좌심실사혈분수(LVEF).결과 재주사rhBNP 15 min시폐모세혈관설압[PCWP(22.7±4.0)mm Hg여(25.3±3.9)mm Hg]、평균폐동맥압[MPAP(31.9±3.6)mm Hg여(34.6±7.8)mm Hg]교기출치명현하강(P＜0.05);수축압재급약후1h하강[(105.2±11.5)mm Hg여(119.0±17.2)mm Hg],차이유통계학의의(P균＜0.01),이후축점회복지기선시수평;용약24h심솔야명현개선[(109.0±10.8)차/min여(82.2±8.6)차/min](P ＜0.01);혈갑、혈납、혈기항무명현변화;용약3d후CI[(3.7±0.6)L/m2여(1.8±0.4)L/m2]화EF[(43.1±8.3)％여(31.2±6.4)％]균유명현개선,LVEDD명현축소[(63.6±5.7)mm여(67.3±6.2)mm](P균＜0.01).미발생여rhBNP상관적증상성저혈압급기타엄중불량반응.결론 정맥응용rhBNP능신속개선RHF환자혈액동역학상황,차안전가행.
Objective To study the effect and safety of recombinant human brain natriuretic peptide (rhBNP)on hemodynamics in patients with refractory heart failure(RHF).Methods A total of 16 patients with RHF were enrolled in the study.We defined RHF as the symptoms and signs had not been improved with conventional intensive treatment.The patients started to receive the infusion of rhBNP with 1.5 μg/kg bolus intravenous injection followed by 0.007 5 μ4/(kg · min)for 24 hours.During 24 hours,the hemodynamic parameters,systolic blood pressure,heart rate and electrolyte were monitored.After rhBNP infused,echocardiography was used to measure the cardiac index(CI),left ventricular end diastolic diameter(LEVDD)and ejection fraction(EF)in the third day.Results After rhBNP infused,pulmonary capillary wedge pressure (PCWP),mean pulmonary artery pressure(MPAP)were significantly reduced at 15 minutes(PCWP[22.7 ±4.0]mm Hg vs[25.3 ±3.9]mm Hg;MPAP[31.9 ±3.6]mm Hg vs[34.6 ±7.8]mm Hg,P ＜0.05),the systolic blood pressure decreased remarkably at one hour([105.2 ± 11.5]mm Hg vs[119.0 ± 17.2]mm Hg,P ＜ 0.01),and the effect disappeared gradually,heart rate decreased remarkably([109.0 + 10.8]beat/min vs [82.2 ± 8.6]beat/min).blood K +,Na + and renal function remained unchanged(P ＞ 0.05).CI([3.7 ± 0.6]L/m2 vs[1.8 ±0.4]L/m2),LEVDD([63.6 ±5.7]mm vs[67.3 ±6.2]mm)and EF([43.1 ±8.3]％ vs [31.2 ± 6.4]％)were significantly improved(P ＜ 0.01).There was no symptomatic hypotension or other adverse events.Conclusion Injection of rhBNP is safe,feasible,and effective in patients with refractory heat failure for improving hemodynamics.
