重组人脑利钠肽与米力农在急性心功能不全患者治疗中的疗效对比观察(2)
BNP的半衰期较短,注射rhBNP能提高循环系统中BNP浓度,能即刻反映心功能改善情况。而N T_proBNP不因外界治疗因素等影响循环中BNP浓度,且其半衰期较长,因此,NT_proBNP是反 映心功能更好的指标[8]。本文结果提示:高剂量rhBNP组患者在接受rhBNP治疗6h 始,NT_proBNP就显著低于用药前及同时间米力农组,并较同时间低剂量rhBNP组更低(P <0.05),且持续至停药后6h,而低剂量组在rhBNP治疗6h时,NT_proBNP虽较用药前有所 下降,但尚无统计学意义,在用药24h出现显著下降。因此,高剂量rhBNP对心功能不全疗效 优于低剂量rhBNP。
本文中三组LVEF于治疗后一周均较前显著提高,但三组间无明显统计学差异。米力农组BNP ,NT_proBNP及CA125水平及血压(SBP)在用药6h、24h及停药6h时均较治疗前有所下降,但 无统计学意义。而两个不同rhBNP剂量组的上述指标及SBP在治疗各个时间点均有所改善,且 持续至停药后6h。显示rhBNP对心功能不全的治疗有效,且在治疗早期优于米力农。既往研 究表明,心衰患者用正性肌力药物如多巴酚丁胺、米力农等可引起心律失常,而rhBNP尚未 明显增加房性或室性心律失常事件[9,10]。本文在用rhBNP治疗心衰患者过程中也 未发现症状性低血压及其他与rhBNP相关的如恶性心律失常等严重不良反应。因此,应用本 文中剂量的rhBNP治疗心功能不全者有效、安全。
, 百拇医药
参考文献
[1]OPTIME_CHF investigators. Short_term intravenous milrinone for theacute exacerbation of chronic heart failure[J]. JAMA,2002,287:1541-1547.
[2]Dee Fontana. Nesiritide: The Latest Drug for Treating Heart Failure[J]. JCrit Care Nurse, 2006,26:39-47.
[3]李世强,傅向华,刘君,等.静脉注射重组人脑利钠肽对急性心肌梗死伴心力衰竭患者的 急性血流动力学效应的研究[J]. 中华心血管病杂志,2006,34:23-27.
[4]Lainchbury JG, Campbell E, Frampton CM, et al. Brain natriuretic peptide a nd N_terminal brain natriuretic peptide in the diagnosis of heart failure in pat ients with acute shortness of breath[J]. J Am Coll Cardiol, 2003,42:728-735.
, 百拇医药
[5]孙水根,黄继华.血清CA125浓度改变对慢性心力衰竭患者临床诊治的价值[J].中华 医学会中华急诊医学杂志,2007,16:424-426.
[6]Miller W L, Hartman KA, Burritt MF, et al. Biomarker Responses during and a fter Treatment with Nesiritide Infusion in Patients with Decompensated Chronic H eart Failure[J]. J Clinical Chemistry, 2005,51:3569-3577.
[7]Colucci WS, Elkayam U, Horton DP, et al. Intravenous nesiritide, a natriur etic peptide, in the treatment of decompensated congestive heart failure. Nesir itide Study Group[J]. J Med N Engl, 2000,343:246-253.
, 百拇医药
[8]Bay M, Kirk V, Parner J, et al. NT_proBNP: a new diagnostic screening toolto differentiate between patients with normal and reduced left ventricular systo lic function[J]. J Heart, 2003,89:150-154.
[9]Burger AJ, Horton DP, Silver M. Effect of nesiritide and dobutamine on ven tricular arrhythmias in the treatment of patients with acutely decompensated con gestive heart failure: the PRECEDENT study[J]. J Am Heart, 2002,144:1102-110 8.
[10]OPTIME_CHF investigators. Short_term intravenous milrinone for the acute e xacerbation of chronic heart failure[J]. JAMA, 2002,287:1541-1547., http://www.100md.com(李利芳,韦凡平,袁高辉,程震峰,张 川)
本文中三组LVEF于治疗后一周均较前显著提高,但三组间无明显统计学差异。米力农组BNP ,NT_proBNP及CA125水平及血压(SBP)在用药6h、24h及停药6h时均较治疗前有所下降,但 无统计学意义。而两个不同rhBNP剂量组的上述指标及SBP在治疗各个时间点均有所改善,且 持续至停药后6h。显示rhBNP对心功能不全的治疗有效,且在治疗早期优于米力农。既往研 究表明,心衰患者用正性肌力药物如多巴酚丁胺、米力农等可引起心律失常,而rhBNP尚未 明显增加房性或室性心律失常事件[9,10]。本文在用rhBNP治疗心衰患者过程中也 未发现症状性低血压及其他与rhBNP相关的如恶性心律失常等严重不良反应。因此,应用本 文中剂量的rhBNP治疗心功能不全者有效、安全。
, 百拇医药
参考文献
[1]OPTIME_CHF investigators. Short_term intravenous milrinone for theacute exacerbation of chronic heart failure[J]. JAMA,2002,287:1541-1547.
[2]Dee Fontana. Nesiritide: The Latest Drug for Treating Heart Failure[J]. JCrit Care Nurse, 2006,26:39-47.
[3]李世强,傅向华,刘君,等.静脉注射重组人脑利钠肽对急性心肌梗死伴心力衰竭患者的 急性血流动力学效应的研究[J]. 中华心血管病杂志,2006,34:23-27.
[4]Lainchbury JG, Campbell E, Frampton CM, et al. Brain natriuretic peptide a nd N_terminal brain natriuretic peptide in the diagnosis of heart failure in pat ients with acute shortness of breath[J]. J Am Coll Cardiol, 2003,42:728-735.
, 百拇医药
[5]孙水根,黄继华.血清CA125浓度改变对慢性心力衰竭患者临床诊治的价值[J].中华 医学会中华急诊医学杂志,2007,16:424-426.
[6]Miller W L, Hartman KA, Burritt MF, et al. Biomarker Responses during and a fter Treatment with Nesiritide Infusion in Patients with Decompensated Chronic H eart Failure[J]. J Clinical Chemistry, 2005,51:3569-3577.
[7]Colucci WS, Elkayam U, Horton DP, et al. Intravenous nesiritide, a natriur etic peptide, in the treatment of decompensated congestive heart failure. Nesir itide Study Group[J]. J Med N Engl, 2000,343:246-253.
, 百拇医药
[8]Bay M, Kirk V, Parner J, et al. NT_proBNP: a new diagnostic screening toolto differentiate between patients with normal and reduced left ventricular systo lic function[J]. J Heart, 2003,89:150-154.
[9]Burger AJ, Horton DP, Silver M. Effect of nesiritide and dobutamine on ven tricular arrhythmias in the treatment of patients with acutely decompensated con gestive heart failure: the PRECEDENT study[J]. J Am Heart, 2002,144:1102-110 8.
[10]OPTIME_CHF investigators. Short_term intravenous milrinone for the acute e xacerbation of chronic heart failure[J]. JAMA, 2002,287:1541-1547., http://www.100md.com(李利芳,韦凡平,袁高辉,程震峰,张 川)