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目的:观察短期静脉内注射国产重组人心钠肽(rhANP)治疗难治性心力衰竭(RHF)患者血流动力学效应及安全性。方法:连续入选住院的RHF患者10例,常规急性HF药物强化治疗无明显改善,开始静脉内给予rhANP0.1μg.kg-1·min-1持续静脉泵入60min。在给药24h内,监测有创血流动力学参数、血压、HR及血清生化指标。结果:在注射rhANP0.5h时,肺毛细血管楔压(PCWP)、平均肺动脉压(MPAP)、中心静脉压(CVP)、体循环阻力(SVR)、肺循环阻力(PVR)较基础值明显下降[PCWP(15.67±4.55):(24.00±4.00)mm Hg(1mm Hg=0.133kPa),P<0.05;MPAP(25.67±6.62):(34.33±7.92)mm Hg,P<0.05;CVP(9.50±3.99):(13.00±3.29)mm Hg,P<0.05;SVR(1121.50±138.64):(1603.67±422.74)dynes×s/cm5,P<0.05;PVR(166.00±57.00):(226.83±74.24)dynes×s/cm5,P<0.05],心指数较基础值明显升高[(3.22±0.35):(2.50±0.38),P<0.05]。这种有益的血流动力学效应可持续到注射后24h。收缩期血压在给药后1h下降最明显(P<0.01),以后恢复至基线时水平。HR、血钾、血钠、血肌酐无明显变化。未发现与rhANP相关的症状性低血压及其他严重不良反应。结论:短期静脉内给予国产rhANP能迅速而持续地改善RHF患者的血流动力学状况,且安全可行。
Objective: To observe the hemodynamic effects and safety of short-term intravenous injection of rhANP in patients with refractory heart failure (RHF). Methods: Ten consecutive hospitalized patients with RHF were enrolled in this study. No significant improvement was observed in patients with conventional acute HF. The patients were started intravenously with rhANP 0.1 μg.kg-1 · min-1 for 60 minutes. Within 24 hours of administration, invasive hemodynamic parameters, blood pressure, HR and serum biochemical parameters were monitored. Results: Pulmonary capillary wedge pressure (PCWP), mean pulmonary arterial pressure (MPAP), central venous pressure (CVP), systemic circulation resistance (PVR) and pulmonary vascular resistance (PVR) (15.67 ± 4.55) :( 24.00 ± 4.00) mm Hg (1mm Hg = 0.133kPa), P <0.05; MPAP (25.67 ± 6.62) :( 34.33 ± 7.92) mm Hg, (13.00 ± 3.29) mm Hg, P <0.05; SVR (1121.50 ± 138.64): (1603.67 ± 422.74) dynes × s / cm5, P <0.05; PVR (166.00 ± 57.00) :( 226.83 ± 74.24) dynes × s / cm5, P <0.05]. The cardiac index was significantly higher than the baseline value [(3.22 ± 0.35) :( 2.50 ± 0.38), P <0.05]. This beneficial hemodynamic effect lasts 24 h after injection. Systolic blood pressure at 1h after administration decreased the most obvious (P <0.01), later returned to baseline levels. HR, serum potassium, serum sodium, serum creatinine no significant change. No symptomatic hypotension and other serious adverse reactions associated with rhANP were found. Conclusion: Short-term intravenous administration of rhANP can rapidly and continuously improve the hemodynamic status of RHF patients and is safe and feasible.