Kurien Shaun, Warfield Karen T, Wood Christina M, Miller Wayne L
Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Am J Cardiol. 2006 Dec 15;98(12):1627-30. doi: 10.1016/j.amjcard.2006.07.044. Epub 2006 Oct 25.
The safety and efficacy of the concomitant use of intravenous diuretics and positive inotropes with nesiritide have not been well studied. There is also a paucity of data examining whether the type of medical therapy before treatment with nesiritide has an effect on outcomes. Data from 167 patients with heart failure and reduced left ventricular ejection fractions (34 +/- 17%) treated with nesiritide were analyzed retrospectively. Baseline oral medications were continued, diuretic regimens were modified, and nitrates were discontinued. Forty-three patients (26%) received intravenous furosemide with nesiritide. The glomerular filtration rate before and after nesiritide infusion was not different in patients treated with versus without furosemide (0.7 +/- 8.8 vs 0.7 +/- 11.0 ml/min/1.73 m(2), p = 0.71). Change in urine output from before to during nesiritide infusion was greater with concomitant furosemide (41 +/- 57 vs 10 +/- 58 m/hour, p = 0.006). There was no significant difference in survival with furosemide (90% vs 89% at 30 days, 62% vs 57% at 12 months, p = 0.63). Thirty-nine patients (23%) received inotrope support with nesiritide. The glomerular filtration rate tended to improve when inotropes were used with nesiritide (3.3 +/- 13.1 vs -0.1 +/- 9.4, ml/min/1.73 m(2), p = 0.17). No significant changes in serum creatinine or urine output were observed with inotrope use. Survival was not worsened in those receiving inotropes (p = 0.51). Also, there were no significant differences in serum creatinine, glomerular filtration rate, or urine output in patients who continued to receive angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta blockers, or digoxin therapy during nesiritide infusion. In conclusion, there were no observed adverse affects of baseline medical therapy, intravenous diuretics, or intravenous inotropes on renal functions or mortality when used in conjunction with nesiritide in the treatment of decompensated chronic heart failure.
静脉利尿剂和正性肌力药物与奈西立肽联合使用的安全性和有效性尚未得到充分研究。关于奈西立肽治疗前的药物治疗类型是否对治疗结果有影响的数据也很匮乏。对167例左心室射血分数降低（34±17%）的心力衰竭患者接受奈西立肽治疗的数据进行了回顾性分析。继续使用基线口服药物，调整利尿剂方案，并停用硝酸盐类药物。43例患者（26%）在使用奈西立肽的同时接受静脉注射呋塞米。使用呋塞米与未使用呋塞米的患者在输注奈西立肽前后的肾小球滤过率无差异（0.7±8.8对0.7±11.0 ml/min/1.73 m²，p = 0.71）。联合使用呋塞米时，奈西立肽输注前至输注期间的尿量变化更大（41±57对10±58 m/小时，p = 0.006）。使用呋塞米的患者生存率无显著差异（30天时为90%对89%，12个月时为62%对57%，p = 0.63）。39例患者（23%）在使用奈西立肽的同时接受了正性肌力药物支持。当正性肌力药物与奈西立肽联用时，肾小球滤过率有改善趋势（3.3±13.1对-0.1±9.4，ml/min/1.73 m²，p = 0.17）。使用正性肌力药物时，血清肌酐或尿量无显著变化。接受正性肌力药物治疗的患者生存率未恶化（p = 0.51）。此外，在输注奈西立肽期间继续接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、β受体阻滞剂或地高辛治疗的患者，其血清肌酐、肾小球滤过率或尿量无显著差异。总之，在失代偿性慢性心力衰竭治疗中，基线药物治疗、静脉利尿剂或静脉正性肌力药物与奈西立肽联合使用时，未观察到对肾功能或死亡率有不良影响。
