重组人脑利钠肽不同给药方式治疗急性失代偿心力衰竭的临床效果比较

Comparison of different administration methods of recombinant human brain natriuretic peptide in treatment of refractory heart failure

摘要:

目的 观察重组人脑利钠肽(rhBNP)滴定给药方法治疗难治性急性失代偿心力衰竭是否优于目前的固定剂量给药方法,并评价其安全性。方法 入选NYHA心功能分级Ⅳa及Ⅳb级的左室射血分数＜35%的急慢性失代偿患者共60例,应用随机数表法随机分为固定剂量和滴定剂量2组,每组30例。固定剂量组根据基线血压情况直接予以rhBNP 0.015μg/(kgmin)静脉泵入,维持治疗48h；滴定剂量组首次负荷1.5μg/kg,然后以起始剂量0.007 5μg/(kgmin),每15min上调0.002 5μg,最大剂量0.030μg/(kgmin),或以目标血压为依据间断上调剂量,至血压稳定至目标血压后继续维持治疗48~96h后停用。观察指标包括主观症状的改善情况,初始24h累积尿量,收缩压及平均动脉压,心率及心律,给予实验药物前后的醛固酮、血清肌酐及肌酐清除率等。采用SPSS 18.0统计软件进行数据分析。计量资料用均数±标准差(±s)表示,组间比较采用t检验；计数资料用例数(百分率)表示,组间比较采用χ²检验。 结果 滴定剂量组患者心力衰竭症状缓解更加明显,好转率明显高于固定剂量组,起始24h尿量明显多于固定剂量组,差异有统计学意义(P＜0.05);与固定剂量组比较,滴定剂量组NT-proBNP水平下降明显,估测肺动脉压力下降,心室动脉偶联比改善,差异有统计学意义(P＜0.05)。结论 rhBNP滴定剂量给药较固定剂量给药能更快缓解急性心力衰竭临床症状,安全性不劣于固定剂量组,对于基线血压正常或偏高、体循环淤血较重的患者疗效及耐受性更好。

Abstract:

Objective To observe whether titration of recombinant human brain natriuretic peptide (rhBNP) is better than the current fixed-dose method and to evaluate its safety in the treatment of refractory acute decompensated heart failure. Methods Enrolled in the study were a total of 60 patients with acute and chronic decompensated heart failure with left ventricular ejection fraction lower than 35% in NYHA cardiac function grades IVa and IVb. They were randomly divided into two groups:fixed-dose group and titrated-dose group, with 30 in each group. The fixed-dose group was not given a preload, and the rhBNP 0.015μg/(kgmin) was intravenously pumped for 48 hours according to the baseline blood pressure. The titrated-dose group was first loaded with rhBNP 1.5μg/kg and titrated with an initial dose of 0.0075μg/(kgmin), which was increased by 0.0025μg every 15min until the maximum of 0.030μg/(kgmin); or the dose was titratably increased based on the target blood pressure and maintained for 48-96h after the target blood pressure was achieved. Indicators observed included improvement of subjective symptoms, 24-hour cumulative urine volume, systolic blood pressure and mean arterial pressure, heart rate and heart rhythm, aldosterone, serum creatinine and creatinine clearance before and after drug administration. SPSS statistics 18.0 was used for data analysis. The measurement data were expressed as mean±standard deviation (±s), and the t test was used for comparison between groups; the numeration data were expressed as the number of cases (percentage), and the χ² test was used for comparison between groups. Results Compared with the fixed-dose group, the titrated-dose group had more obvious relief of heart failure symptoms, better improvement rate and higher urine volume at the initial 24 hours, greater decrease of NT-proBNP, greater increase in pulmonary artery pressure, and more improved ventricular artery coupling ratio, the differences being statistically significant (P<0.05). Conclusion Titrated dose of rhBNP can relieve the clinical symptoms of acute heart failure faster than the fixed dose, with the safety being not inferior to that of the latter. The efficacy and tolerability are better in the patients with normal or high baseline blood pressure and severe systemic congestion.