Efficacy Investigation Of Early Application Of Recombinant Human Brain Natriuretic Peptide In The Treatment Of Acute Heart Failure

Objective:Acute heart failure is a common medical acute critical illness, which is acute onset and rapid progression and the severe cases can lead to cardiogenic shock and sudden death. The structure and function of the heart are changed dramatically when heart failure and caused worsening symptoms, thus creating a vicious cycle. Brain natriuretic peptide(BNP),BNP is a cardiac neurohormone secreted by the left ventricle when ventricular dilatation and ventricular pressure load increases. It has many effects, such as natriuresis, diuresis, vasodilation, against the renin-angiotensin-aldosterone system activity; inhibit excessive sympathetic response, regulating blood pressure and blood volume. Further confrontation sodium and water retention. Recombinant human brain natriuretic peptide(rh-BNP),rh-BNp is a biologics synthesis of DNA technology, it has the same amino acid sequencing, spatial structure and biological activity with the endogenous BNP. Therefore, rh-BNP also has the same effcts, such as natriuresis, diuresis, vasodilation and antagonism of the renin- angiotensin- aldosterone system. So it can delay ventricular remodeling and improve heart failure symptoms. This study was designed to investigate the efficacy and safety when treating acute heart failure early use rh-BNP. Explore new effective method for the treatment of acute heart failure.Methods: One hundred and twenty patients who in our hospital and diagnosed with acute left ventricular failure were selected, which from January 2010 to February 2015. They were randomly divided into two groups, among them, 60 cases of conventional treatment group, 60 cases are in the observation group. Conventional anti-heart failure treatment group received conventional therapy. The specific method is reference "2010 China Heart Failure Diagnosis and treatment guidelines." Observation group were treated with rh-BNP on the basis of conventional therapy, and giving rh-BNP injection(Chengdu Nuodikang Biopharmaceutical Co., Zhunzi: S20050033), in 1.5ug / kg after intravenous injection continued to 0.0075 ug /(kg.min) intravenous infusion once every 72 h or more. Close monitoring of the patient’s condition in a patient during treatment. Observe of the patient’s symptoms of heart failure after the treated and evaluated for efficacy at 72 hours after treatment. After treatment, patients observed relief of symptoms of heart failure, patients before and after treatment 72 hours’ blood serum BNP levels. Before treatment and after two weeks underwent Holter. Monitoring of heart rate variability(HRV), Include: standard sinus cardiac RR interval difference(SDNN, SDANN,r MSSD,PNN50,LF, HF). Before treatment and after 4 weeks underwent echocardiographic indicators for monitoring include: left atrial diameter(LA), left ventricular end-diastolic dimension(LVEDD), left ventricular end-systolic dimension(LVESD),Stroke volume(SV),Cardiac output(CO), Left ventricular ejection fraction(LVEF); Were observed in the average length of stay, bed time, eight weeks 6MWT data monitoring after treatment, discharged two months after the follow-up readmission rates.Results:1 Heart Failure Efficacy evaluation comparison: two groups of patients to assess the therapeutic effect after 72 h Show: observation group 48 cases markedly effective, 8 patients are effective, 4 cases are invalid, the total efficiency of 93.3%; treatment group, 40 cases markedly effective, 9 patients are effective,11 cases are invalid, which killed one case, the total effective rate was 81.7%; cardiac function improved overall efficiency of the observation group were significantly and markedly higher than conventional group, the difference was statistically significant(P<0.05).2 Serum BNP comparison: Two groups of patients before treatment were higher serum BNP, Observed before treatment serum BNP(961.34±23.59) pg / ml, Treatment group before treatment, serum BNP was(958.43±23.25) pg / ml, Two groups showed no significant difference(P>0.05). Observed after treatment serum BNP was(121.12±39.26) pg / ml, After treatment, treatment group serum BNP was(241.56±24.23) pg / ml, After treatment, compared with pre-treatment BNP were significantly decreased, the difference was statistically significant, but the observation group decreased more significantly, There was statistically significant(P<0.05) was observed between the treatment group and the comparison group differences between groups after treatment.3 HRV indicators for monitoring the comparison: Before treatment, the treatment group HRV indexes(HR, SDNN, SDANN, r MSSD, PNN50, LF, HF) was(112.9±10.8 beats/min,78.2±8.6 ms,55.8±8.1 ms,25.1±6.3 ms,4.7±1.0 %,163.6±10.2 ms2,67.0±7.0 ms2), Respectively, after treatment(79.2± beats/min,81.1±8.3 ms,56.0±8.3 ms,26.7±3.4 ms,5.1±0.9 %,170.7±7.7 ms2,72.5±4.9 ms2), Before treatment, the observation group in HRV(HR, SDNN, SDANN, r MSSD, PNN50, LF, HF) was(116.1±10.8 beats/min,77.7±9.0 ms,55.6±8.3 ms,25.2±6.3 ms,4.6±0.9 %,167.0±10.2 ms2,62.7±6.9 ms2) respectively, after treatment(69.7±18.8 beats/min,118.7±7.1 ms,89.9±7.7 ms,37.1±5.2 ms,5.8±0.6 %,224.9±17.5 ms2,92.9±7.9 ms2), the HRV indexes degree of improvement in patients in the observation group was significantly superior to the conventional treatment group(P<0.05).4 Comparison of two groups of cardiac function: The LAD, LVEDD, LVESD, LVEF, SV, CO were improved of two groups patients after treatment. Monitoring of indicators before and after treatment in the observation group were: LA(48.7±8.8mm,47.8±6.8mm),LVEDD(68.2±9.5mm,59.3±7. 4mm),LVESD(56.2±8.4mm,48.2±7.1mm),LVEF(31.9±4.7%,48.4±4.6%)、SV(38.2±4.1ML/times、48.5±6.2ML/times), CO(3.2±1.2L /min,4.8±1. 3L/min). Indicators before and after treatment in patients treated with conventional were: LA(48.9±8.6mm,48.5±6.5mm),LVEDD(69.1±10.2mm, 64.2±9.8mm), LVESD( 55.8±7.6mm, 52.3±6.7mm),LVEF(32.1.9±4.8%,40.9±5.7%),SV(37.6±4.5ML/times,42.6±6.1ML/times),CO(3.3±1.1L/min,4.2±1.2L/min). The observation group were significantly improved cardiac function parameters better than conventional treatment group, the difference was statistically significant(P<0.05).5 Two groups of patients hospitalized time, bed time, in-hospital mortality and follow-up 6-minute walk distance after two months and compare readmission rates: Compared with the conventional treatment group, the observation group were significantly shorter hospital stay, hospital mortality decreased 6-minute walk distance increased after two months and reduce readmission rates, the differences were statistically significant.Conclusions:1 In patients with acute heart failure the early application of rh-BNP can effectively control the clinical symptoms of heart failure and shortened hospital stay and improve quality of life.2 Rh-BNP can block the vicious cycle of RAAS, improve cardiac remodeling and improve heart function obviously.3 By controlling the happen of fatal arrhythmia, Rh-BNP can improve heart rate variability in patients with acute heart failure, then the hospitalization sudden death and the readmission rates can be reduced.