摘要
目的探讨静脉注射重组人B型利钠肽(rhBNP)对急性失代偿性心力衰竭(ADHF)合并急性肾损伤(AKI)患者心、肾功能的影响及预后。方法 40例符合ADHF合并AKI的患者纳入研究,在常规利尿剂应用无效的基础上,20例患者予利尿剂加量治疗(对照组),20例予rhBNP静脉注射治疗(治疗组)。观察两组治疗前后血肌酐(SCr)、估算的肾小球滤过率(eGFR)、血浆B型利钠肽(BNP)水平及左心室射血分数(LVEF)的变化。随访90d的死亡率、再住院率、再发心力衰竭及肾功能的变化。结果治疗组治疗后48h的SCr水平显著低于对照组(P<0.01);治疗后7d的eGFR和LVEF均显著高于对照组(P值分别<0.05、0.01),血浆BNP水平显著低于对照组(P<0.01);两组治疗后收缩压的差异无统计学意义(P>0.05)。随访90d,对照组再住院8例(40%),再发心力衰竭8例(40%),肾功能恢复12例(60%),死亡3例(15%);治疗组再住院4例(20%),再发心力衰竭2例(10%),肾功能恢复14例(70%),死亡1例(5%)。结论对ADHF合并AKI患者应用rhBNP静脉注射治疗较利尿剂加量治疗能更有效地改善患者的心、肾功能。
Objective To investigate the effect of intravenous injection of recombinant human B-type natriuretic peptide（rhBNP） on heart and renal function in the patients suffered from acute decompensated heart failure（ADHF） combined with acute kidney injury（AKI） and the prognosis.Methods Forty patients with ADHF combined with AKI were enrolled in this study.After invalidation of routine diuretics therapy,20 patients in control group were intravenously given additional diuretics,and 20 patients in rhBNP group were intravenously given rhBNP.Serum creatinine（SCr）,estimated glomerular filtration rate（eGFR）,serum B-type natriuretic peptide（BNP） and left ventricular ejection fraction（LVEF） were measured before and after treatment.Mortality,rehospitalization rate,recurrence of heart failure and renal function were followed up for 90 days.Results SCr in rhBNP group was significantly lower than that in control group 48 h after treatment（P0.01）.eGFR and LVEF in rhBNP group was significantly higher than those in control group（P0.05,P0.01） and serum BNP level in rhBNP group were significantly lower than that in control group（P0.01） 7 d after treatment.Until day 90 of follow-up,3 patients（15%） died,8（40%） were rehospitalized,8（40%） had recurred heart failure and 12（60%） had restored renal fanction in control group;1（50%） died,4（20%） were rehospitalized,2（10%） had recurred heart failure and 14（70%） had restored renal fanction in rhBNP group.Conclusion Compared with additional diuretics therapy,intravenous rhBNP therapy may effectively improve the heart and renal function in the patients with ADHF combined with AKI.
出处
《上海医学》
CAS
CSCD
北大核心
2011年第12期938-941,共4页
Shanghai Medical Journal
关键词
重组人脑利钠肽
利尿剂
急性失代偿性心力衰竭
急性肾损伤
心功能
肾功能
Recombinant B-type natriuretic peptide
Diuretics
Acute decompensated heart failure
Acute renal injury
Heart function
Renal function
