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目的观察基因重组人脑利钠肽(rhBNP)治疗心力衰竭伴肺动脉高压的效果。方法 40例心力衰竭伴肺动脉高压患者,随机分为静脉滴注rhBNP组和对照组,每组20例。两组患者均给予降低肺动脉压及改善心功能等基础治疗。比较用药前及用药48 h后两组患者有创血流动力学参数、左心功能、肺动脉压、不良反应和治疗2周内的主要不良心脏事件(MACE)的发生情况。采用SPSS 15.0软件处理;计量资料采用配对t检验,计数资料用χ~2检验,P<0.05为差异有统计学意义。结果 rhBNP组和对照组间及用药前后中心静脉压(CVP)和收缩压(SBP)无明显变化。rhBNP组用药48 h后的肺毛细血管楔压(PCWP)较对照组明显降低(P<0.05)。2周后,rhBNP组左室射血分数及肺动脉压较对照组显著改善(P<0.05)。本研究未发现严重不良反应,仅发现1例与rhBNP相关的症状性低血压。两组治疗2周内的主要心血管事件的发生情况相似。结论对于心力衰竭伴肺动脉高压患者,滴注rhBNP可降低PCWP,改善心功能,可明显改善患者症状,但不影响血流动力学,是安全有效的治疗心力衰竭伴肺动脉高压的药物。
Objective To observe the effect of recombinant human brain natriuretic peptide (rhBNP) on heart failure and pulmonary hypertension. Methods Forty patients with heart failure and pulmonary hypertension were randomly divided into intravenous drip group (rhBNP) and control group (n = 20). Two groups of patients were given to reduce pulmonary arterial pressure and improve cardiac function and other basic treatment. The incidences of invasive hemodynamics, left ventricular function, pulmonary arterial pressure, adverse reactions, and major adverse cardiac events (MACE) were compared between the two groups before and 48 h after treatment. Using SPSS 15.0 software processing; measurement data using paired t test, count data with χ ~ 2 test, P <0.05 for the difference was statistically significant. Results There was no significant change of CVP and SBP between rhBNP group and control group before and after treatment. Pulmonary capillary wedge pressure (PCWP) in rhBNP group after 48 h was significantly lower than that in control group (P <0.05). After 2 weeks, left ventricular ejection fraction and pulmonary arterial pressure in rhBNP group were significantly improved compared with those in control group (P <0.05). The study found no serious adverse reactions, found only 1 case of rhBNP-related symptomatic hypotension. The occurrence of major cardiovascular events within two weeks of treatment was similar in both groups. Conclusion In patients with heart failure and pulmonary hypertension, instillation of rhBNP can reduce PCWP, improve cardiac function, can significantly improve the patient’s symptoms, but does not affect hemodynamics, is safe and effective treatment of heart failure with pulmonary hypertension drug.