| Objective:To evaluate the efficacy and safety of intravenous recombinant human brain natriuretic peptide in treating patients with coronary artery disease complicated acute heart failure.Methods:273patients coronary artery disease complicated with acute heart failure were randomly divided into two groups:rhBNP group (n=138,1.5μg·kg-1bolus intravenous injection followed by0.00755μg·kg-1·min-1for72hours) and control group (n=135, no receiving any other treatment except essential therapy). The two groups were both given platelet inhibitor, heparin, statins, diuretics, nitrates, ACEI or ARB in general and interventional therapy or thrombolysis if they had the indication, and cardiotonic agents if necessary. The improvement rate of clinical symptoms and the heart rate, blood pressure and CVP were respectively recorded before and after medicine administration at the first, sixth, twelfth, twenty-forth, forty-eighth and seventy-second hours. We monitored patients’ urine volume after medicine administration for72hours. Watch the progress echo-cardiogram before and after medicine administration at the third and seventh days, record LADD, LVDD, IVST and LVEF. Besides, we recorded the peak of the CK and CK-MB and the results of the signs of kidney function for72hours. The level of BNP in serum was documented before the administration and6hours after infusion withdraw. NYHA classes were also recorded after medicine administration. Record the length of stay and the rate of malignant cardiac incidents in a week. Results:The improvement rate of dyspnea in rhBNP group at the sixth, forty-eighth, seventy-second hours and the improvement rate of rales at forty-eighth, seventy-second hours after medicine administration obviously preceded than that of control group (P<0.05). While heart rate reduced at the twelvth hour in control group, reduced at various time points in rhBNP group. The heart rate in the rhBNP group got lower at sixth hour, forty-eighth and seventy-second (P<0.05). The blood pressure became lower after therapy in rhBNP group, but two groups’ discrepancy had no statistical meaning. The CVP of the rhBNP group reduced at every point after medicine administration, Urine output both increased, and increased more in rhBNP group. Compared to baseline level, in rhBNP group, LVEF markedly increased after medicine administration in the third and seventh days, and was higher than control group in the seventh day (P<0.05), while only the LVDD reduced in the seventh day in control group (P<0.05). The BUN, UA and SCr increased after medicine administration in the rhBNP group (P<0.05), but there was no significant difference between the two groups. The peak of the CK and CK-MB was lower in the rhBNP group than in the control group (P<0.05). Plasma level of BNP after administration in rhBNP group was significantly lower than that of control group (P<0.05). There were better improvement rate of NYHA classes in rhBNP groups. The cardiac events and the CCU hospital stay were similar between the two groups. There was no significant difference between the two groups in adverse events related to drugs. Conclusion:RhBNP is superior to the conventional drugs in improving dyspnea and reducing rales. It can decrease the heart rate and CVP in patients without affecting the blood pressure. Transvenous injection of rhBNP combined with other routine treatment can improve the left ventricular function and further inhibit the remodeling of left ventricular. Intravenous rhBNP in treating patiens with acute heart failure was secure. |
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