Jefferies John L, Price Jack F, Denfield Susan W, Chang Anthony C, Dreyer William J, McMahon Colin J, Grenier Michelle A, Clunie Sarah K, Thomas Anne, Moffett Brady S, Wann Tiffany S, Smith E O'Brian, Towbin Jeffrey A
Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas 77030, USA.
J Card Fail. 2007 Sep;13(7):541-8. doi: 10.1016/j.cardfail.2007.04.005.
We hypothesized that recombinant B-type natriuretic peptide (BNP) (nesiritide) could improve urine output and neurohormonal markers of heart failure without worsening renal function in pediatric patients.
We analyzed our experience involving 140 nesiritide infusions in 63 consecutive children. Serum levels of BNP and electrolytes were measured before and after therapy. Dosing was begun at 0.01 mcg.kg.min without a bolus and titrated to a maximum of 0.03 mcg.kg.min, in 0.005-mcg.kg.min increments. Blood pressure, heart rate, and heart rhythm were monitored. In a substudy, 20 patients with decompensated cardiomyopathy-related heart failure received 72 hours of nesiritide with prospective assessment of aldosterone, norepinephrine, plasma renin, and endothelin-1 levels before and after therapy. The heart rate decreased significantly (P = .001). Urine output increased significantly on Days 1 and 3 (P < or = .001 and .004, respectively). The mean serum creatinine level decreased from 1.135 to 1.007 mg/dL (P < or = .001). In the substudy, aldosterone levels decreased from 37.5 +/- 57.1 to 20.5 +/- 41.9 ng/dL (P = .005). Plasma renin, norepinephrine, and endothelin-1 levels decreased nonsignificantly. Two infusions were discontinued because of hypotension.
Nesiritide safely treated decompensated heart failure in children. Increased urine output reflected improving renal function. Improved neurohormonal markers were seen after 72 hours of therapy, and complications were uncommon.
我们推测重组B型利钠肽（BNP）（奈西立肽）可改善小儿患者的尿量及心力衰竭的神经激素指标，且不会使肾功能恶化。
我们分析了连续63例儿童接受140次奈西立肽输注的经验。在治疗前后测定BNP和电解质的血清水平。给药起始剂量为0.01 mcg.kg.min，不给予负荷剂量，以0.005 mcg.kg.min的增量滴定至最大剂量0.03 mcg.kg.min。监测血压、心率和心律。在一项子研究中，20例失代偿性心肌病相关心力衰竭患者接受了72小时的奈西立肽治疗，并对治疗前后的醛固酮、去甲肾上腺素、血浆肾素和内皮素-1水平进行了前瞻性评估。心率显著下降（P = 0.001）。第1天和第3天尿量显著增加（分别为P≤0.001和0.004）。平均血清肌酐水平从1.135降至1.007 mg/dL（P≤0.001）。在子研究中，醛固酮水平从37.5±57.1降至20.5±41.9 ng/dL（P = 0.005）。血浆肾素、去甲肾上腺素和内皮素-1水平无显著下降。因低血压停止了2次输注。
奈西立肽可安全治疗儿童失代偿性心力衰竭。尿量增加反映肾功能改善。治疗72小时后神经激素指标得到改善，且并发症少见。
