Comparison of the efficacy and the safety of different doses of recombinant human brain natriuretic peptide in the treatment of acute decompensated heart failure combined with renal insufficiency / 中国医师进修杂志

ABSTRACT

Objective:To analyze the clinical value of different doses of recombinant human brain natriuretic peptide (rhBNP) in the treatment of acute decompensated heart failure (ADHF) combined with renal insufficiency.Methods:Eighty patients with ADHF combined with renal insufficiency admitted to Jiaxing Second Hospital from December 2018 to January 2020 were selected. According to the random number table method, they were divided into A, B group, with 40 cases in each group. Two groups were treated with the conventional anti heart failure combined with rhBNP. The rhBNP loading doses of A and B group were 0.1 μg/kg. Group A was continually given rhBNP 0.01 μg/(kg·min) for 24 h after the loading dose, while group B was continually given 0.015 μg/(kg·min) rhBNP for 24 h. The efficacy of the two groups was compared, changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory frequency (RR), heart rate (HR) and the degree of dyspnea of patients before and after the medication were monitored, and changes of serum creatinine (Scr), Cystatin C (Cys-C), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), N-terminal pro B-type natriuretic peptide (NT-proBNP) and other cardiorenal function indexes of patients were determined. The changes of 24 h urine output were calculated, estimated glomerular filtration rate (eGFR) was counted, and the occurrence of adverse reactions and the incidence of major cardiovascular adverse events in the last 4 weeks in the two groups were observed.Results:There was no significant difference in the efficacy classification between group A and group B ( P > 0.05). After 24 h of administration, the scores of HR and dyspnea in group B were lower than those in group A [(83.86 ± 4.75) times/min vs. (86.52 ± 5.77) times/min, (1.52 ± 0.43) points vs. (1.89 ± 0.34) points] ( P<0.05). At the end of the treatment, the level of LVEF in group B was higher than that in group A [(47.52 ± 5.41)% vs. (43.75 ± 4.53)%], and the level of NT-proBNP was lower than that in group A [(3 652.41 ± 462.56) ng/L vs. (3 986.57 ± 314.21) ng/L] ( P<0.05). At the end of the treatment, the level of Scr of the two groups decreased and 24 h urine output increased, but there was no statistically significant difference between the two groups ( P>0.05). There was no statistically significant difference in the incidence of adverse reactions and adverse cardiovascular events between groups A and B ( P>0.05). Conclusions:0.015 μg/(kg·min) rhBNP maintenance therapy is more effective in improving cardiac function compared with that of 0.01 μg/(kg·min) maintenance doses in the treatment of ADHF combined with renal insufficiency, and it is safe and feasible without aggravating renal impairment of patients.