Xie Chang-lian, Meng Su-rong, Wang Wei, Chen Shao-min, Li Peng, Feng Xu-guang
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2008 May;28(5):839-42.
To compare the therapeutic effect of recombinant human brain natriuretic peptide (rhBNP) and nitroglycerin on acute decompensated heart failure (ADHF).
Fifty ADHF patients were randomly divided into rhBNP group and nitroglycerin group. In all the patients, dyspnea and global clinical status were assessed before and at 30 min, 6 h and 24 h after drug administration, and the volume of fluid intake and urine along with hemodynamic parameters was recorded 24 h after drug administration. In the nitroglycerin group, the patients received an initial nitroglycerin dose of 5 microg/min, with subsequent dose increment of 5 microg/min every 3 to 5 min; the dose was adjusted individually according to the hemodynamics of the patients. The patients in rhBNP group were given rhBNP at the initial dose of 1.5 microg/kg by with an intravenous bolus injection followed by infusion at the rate of 0.0075 microg.kg(-1).min(-1) for 72 h.
At 30 min and 6 h after drug administration, the patients in the rhBNP group showed significant greater improvement of dyspnea (P=0.042 and 0.019) and global clinical status (P=0.018 and 0.044) than those in the nitroglycerin group, but 24 h after drug administration, no significant difference was noted between the two groups (P=0.192 and 0.179). Twenty-four hours after drug administration, the mean urine volume was significantly greater in rhBNP group than in nitroglycerin group (1513.8-/+242.9 vs 1341.2-/+239.7 ml, P=0.015), and the ejection fraction increased and pulmonary arterial pressure and systolic blood pressure decreased at greater amplitude in the former group (P=0.001,0.000 and 0.002, respectively). At 72 h, the numbers of premature ventricular contraction and couplets premature beats and onset of paroxysmal ventricular tachycardia were significantly reduced in rhBNP group as compared with the nitroglycerin group (P=0, 0.001 and 0.002, respectively).
RhBNP promotes urine excretion, decreases pulmonary arterial pressure and increases left ventricular ejection fraction to improve dyspnea and global clinical status and reduce the onset of ventricular arrhythmia in ADHF patients.
比较重组人脑利钠肽（rhBNP）与硝酸甘油对急性失代偿性心力衰竭（ADHF）的治疗效果。
将50例ADHF患者随机分为rhBNP组和硝酸甘油组。所有患者在用药前及用药后30分钟、6小时和24小时评估呼吸困难及整体临床状况，并记录用药后24小时的液体摄入量、尿量及血流动力学参数。硝酸甘油组患者初始剂量为5微克/分钟，随后每3至5分钟剂量增加5微克/分钟；根据患者血流动力学情况个体化调整剂量。rhBNP组患者先静脉推注初始剂量1.5微克/千克的rhBNP，随后以0.0075微克·千克⁻¹·分钟⁻¹的速率输注72小时。
用药后30分钟和6小时，rhBNP组患者的呼吸困难（P = 0.042和0.019）及整体临床状况（P = 0.018和0.044）改善程度显著大于硝酸甘油组，但用药后24小时，两组间无显著差异（P = 0.192和0.179）。用药后24小时，rhBNP组平均尿量显著多于硝酸甘油组（1513.8±242.9对1341.2±239.7毫升，P = 0.015），且rhBNP组射血分数增加，肺动脉压和收缩压下降幅度更大（分别为P = 0.001、0.000和0.002）。72小时时，rhBNP组室性早搏、成对早搏及阵发性室性心动过速的发作次数较硝酸甘油组显著减少（分别为P = 0、0.001和0.002）。
RhBNP促进ADHF患者排尿，降低肺动脉压，增加左心室射血分数，改善呼吸困难及整体临床状况，并减少室性心律失常的发作。
