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目的:比较静脉注射重组人脑钠尿肽(recombinant human brain natriuretic peptide,rhBNP)对伴有不同水钠潴留程度的急性失代偿心力衰竭(ADHF)患者的血流动力学作用及临床疗效。方法:我院40例ADHF住院患者按水钠潴留程度分为试验组(中重度者,20例)和对照组(轻度者,20例),各组再随机抽取10例应用Swan-Ganz导管进行血流动力学监测,记录给药前及给药后0.5、1、3、6及24 h肺毛细血管楔压(PCWP)、肺动脉压(PAP)和右房压(RAP)并通过热敏稀释法测定心排出量(CO),计算心脏指数(CI)。所有患者均给抗心力衰竭治疗并给予rhBNP,首先以2μg/kg静脉冲击,随后以0.01μg/(kg.min)连续静脉滴注24 h,记录两组患者给药前及给药后0.5、1、3、6及24 h的呼吸困难及整体临床状况改善程度,以及用药后24 h液体出入量。结果:与对照组比较,试验组患者呼吸困难及整体临床状况改善更明显,并伴随更佳的利尿作用[(2.7±0.8)Lvs.(1.7±0.4)L,P=0.01]。试验组PCWP及RAP下降较迅速、明显且稳定持久,两组间PAP比较无统计学差异。两组CI比较组内及组间均无明显统计学差异。结论:伴有中重度水钠潴留的ADHF患者较伴有轻度水钠潴留的患者应用rhBNP治疗有更好的急性血流动力学效应和临床效果,可能是rhBNP临床使用的最佳人群。
Objective: To compare the hemodynamic effects and clinical effects of intravenous injection of recombinant human brain natriuretic peptide (rhBNP) in patients with acute decompensated heart failure (ADHF) with different levels of sodium and water retention. Methods: Forty patients with ADHF in our hospital were divided into experimental group (20 moderate and severe) and control group (20 mild) according to the degree of sodium and sodium retention. Twenty patients in each group were randomized to receive Swan-Ganz catheter Hemodynamic monitoring was performed. Pulmonary capillary wedge pressure (PCWP), pulmonary artery pressure (PAP) and right atrial pressure (RAP) were recorded before and 0.5, 1, 3, 6 and 24 h after administration. Dilution method was used to measure cardiac output (CO) and calculate cardiac index (CI). All patients were given anti-heart failure treatment and given rhBNP, first 2μg / kg intravenous impact, followed by continuous intravenous infusion of 0.01μg / (kg.min) for 24 h, before and after administration of both groups were recorded 0.5 and 0.5, 1,3,6 and 24 h of dyspnea and the overall improvement of clinical conditions, and 24 h after administration of fluid intake and exit. RESULTS: Compared with the control group, dyspnea and overall clinical condition improved more significantly in the test group with a more favorable diuretic effect [(2.7 ± 0.8) L vs (1.7 ± 0.4) L, P = 0.01]. The decline of PCWP and RAP in the experimental group was rapid, obvious and stable, with no significant difference between the two groups. There was no significant difference between the two groups in the CI group and between groups. CONCLUSIONS: Patients with ADHF associated with moderate-to-severe sodium-retention have better acute hemodynamic effects and clinical effects than rhBNP treated with mild sodium-retention syndrome and may be the best clinical candidates for rhBNP.