| Objective: to observe the clinical curative effect and security of rhBNP treatment in patients with refractory heart failure, to explore more suitable methods.Selection methods: Continuous selection 60 patients(in ShiJiazhuang Great Wall hospital combine traditional Chinese and western medicine in August 2014 to August 2014)which meet the criteria of refractory heart failure diagnostic, and remove those exclusion criteria, cardiac function class Ⅲ-Ⅳ(NYNA hierarchical) there are 30 men patients, 30 women patients.Among them:19 caes with DCM, 17 cases with ischemic cardiomyopathy, 15 cases with hypertensive heart disease,4 cases with alcoholic cardiomyopathy, 5 cases with valvular heart disease, using randomized grouping principle, according to the proportion of 1:1, divided into treatment group and control group. There was no significant difference(P > 0.05)and comparable in gender, age, degree of disease progression, between Two groups. The standard heart failure therapy of Two groups are in accordance with the China of diagnosis and treatment of heart failure and treatment guidelines,2014.including bed rest, oxygen, and a low sodium diet, diuresis, application of nitrate and sodium nitrate tome vascular treatment, and reasonable application of digitalis ACEI drugs, angiotensin converting enzyme inhibitors(ACEI drugs can change to ARB drugs), aldosterone antagonists, anti-infection and measures such as treatment of the primary disease. The treatment group patients add rhBNP( trade name is new element), specific usage: first to load 1.5 ug/kg intravenous injection, then according to the maintenance dose of 0.0075 ug/(kg. Min) continuous intravenous pumping. It last seven days; Record the general vital signs and cardiothoracic ratio of patients in two groups when they admission the hospial,.use echocardiography to measure left ventricular contraction, diastolic diameter and LVEF, and measure the plasma NT- Pro BNP concentration change of indicators of patients before and after the treatment.Results: 30 cases in rhBNP treatment group :18 people were markedly improved after treatment, 10 people effectively, 2 is invalid, the total effective rate is 93.3%; Meanwhile in rhBNP treatment group,expiratory dyspnea, clinical situation improved obviously, such as treatment after cardiothoracic ratio and left ventricular end-diastolic diameter and left ventricular ejection fraction increased, decreased plasma NT- Pro BNP concentration after 1 week treatment; There are 4 cases had adverse reactions in RhBNP treatment group, 1 patient with transient hypotension, 3 cases had mild dizziness and headache, through micro adjustment of the dosing speed and symptomatic treatment like kill the pain to control adverse reactions, treatment and the incidence of 13.3%. 30 cases of control group with Conventional treatment : 14 people were markedly improved, effective 7, 9 invalid, total effective rate is 66.7%; At the same time after conventional treatment control group patients with dyspnea after 1 week treatment, clinical situation has improved, after treatment the cardiothoracic ratio and left ventricular end-diastolic diameter and left ventricular ejection fraction increased, decreased plasma NT- Pro BNP concentrations are all improved; 6 cases had adverse reactions during treatment process; 4 cases occur hypotension, 2 cases after to slow delivery speed or stopped the drug,their blood pressure rose to normal, the other 2 cases correct hypotension by given drugs(intravenous application of dopamine), 2 patients appeared dizziness, nausea, after giving anti-nausea treatment these symptoms disappeared, the incidence is 20%.Data comparison of two groups before and after treatment in clinical symptoms and signs of lung’s and other cardiac index were improved, like dyspnea, edema, anorexia, fatigue, index of treatment group improved more obviously than the control group, to compare the data of two groups was statistically significant(P < 0.05).Conclusion: rhBNP treatment has significant efficacy in patients with refractory heart failure, which is worth popularizing in clinical research. |
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