The Clinical Observation Of Intravenous Recombinant Human Brain Natriuretic Peptide In Treating Patients With Acute Myocardial Infarction Complicated With Heart Failure

Objective:To evaluate the efficacy and safety of intravenous recombinant human brain natriuretic peptide in treating patients with acute myocardial infarction complicated with heart failure.Methods:Total of93patients suffered from AMI with heart failure were divided into two groups:rhBNP group (n=44,1.5μg/kg bolus intravenous injection followed by0.0075μg·kg-1·min-1for72hours) and control group (n=49, no receiving any other treatment except essential therapy). There were21patients who received early reperfusion therapy in rhBNP group and25patients in control group. The two groups were both given platelet inhibitor, heparin, nitrates, statins, BB and ACEI in general during the period; and furosemide and sodium nitroprusside if necessary. Progress recording of decompensation straightens’up rate and heart rate was respectively carried out at the point of lhour,6hours,24hours,48hours and72hours after medicine administration.Watching the progress echo-cardiogram fore and after medicine administration for one to two weeks, contrast to LADD, LVDD, IVST and LVEF. The level of BNP in serum were documented before the administration and6hours post infusion withdraw. Killip classes were also recorded after medicine administration. We monitored patients’urine volume after medicine administration for72hours, potassium(K+) of blood, and kidney function, recording the CCU(coronary care unit) hospital stay and the rate of malignant heart failure incidents in a week.Results:The decompensation straightens’up rates in rhBNP group obviously preceded than those of control group at the point of1hour,6hours and48hours after medicine administration (P<0.05), but the aspects of the patients who received early reperfusion therapy in rhBNP group were not better than those of control group. Heart rate remained reduced at various time points in both groups, however, the rhBNP group got lower. There were better Killip classes after treatment than before in both groups with KillipⅡ, but two had no difference. After administration the Killip classes of rhBNP group with KillipⅢ was also better than the aspect of control group(P <0.05). Plasma levels of BNP after administration in rhBNP group was significantly lower tban that of control group(P=0.013). Compared to baseline level, LVEF was markedly increased (P<0.01) and LVDDwas significantly reduced (P<0.05) after medicine administration for one or two weeks in rhBNP group, while the aspects of control group were steady. Both the two group who received early reperfusion therapy got their increases in LVEF after administration, but two had no difference also. Urine output ang liquid input had no significant difference between the two groups, but more furosemide was given the control group, and hypokalemia was found easily in the group. The rate of arrhythmia in rhBNP group was significantly lower than that of control group (P<0.05), while other cardiac events were similar between the two groups.The CCU hospital stay of rhBNP group was significantly shorter than that of another group (P<0.01). Two groups’ discrepancy had no statistical meaning in adverse events related to drugs(P>0.05).Conclusion:rhBNP is superior to the conventional drugs in improving dyspnea and symptoms and in heart rate decreasing in AMI patients. 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 AMI complicated with heart failure was secure.