【摘要】 目的:了解B型利钠肽(BNP)治疗对心衰患者血流动力学的效应及其安全性和耐受性。方法:以充血性心衰为主题词,B-typenatriureticpeptide和nesiritide分别为文本词,对Medline数据库检索临床随机对照试验(RCT),对各试验的方法学和结果等进行评价。结果:8个临床随机对照试验被纳入,结果是BNP的人工合成制剂nesiritide使肺毛细血管楔压(PCWP)平均降低4.06mmHg,95%CI[-4.79,-3.33],P<0.00001,心脏指数(CI)增加0.08L/min·m2,95%CI[0.02,0.15],P=0.01,低血压发生率增加,RR=3.36[2.15,5.26],P=0.01,心动过缓发生高于对照,RR=4.99[1.70,14.60],P=0.003,而室性心律失常两组相似。结论:BNP能有效改善心衰患者血流动力学,改善近期预后,呈剂依赖;明显降低严重心衰患者且危险因素≥4个患者的远期死亡率;Nesiritide治疗虽存在低血压等诸多副作用,但一般患者均能耐受。更多还原

【Abstract】 Objective:To assess the beneficial and harmful effects of congestive heart failure (CHF) treatment with human-b-type natriuretic peptide and the tolerance of patients.Methods:Searched the randomized controlled trials(RCTs) in Medline database with congestive heart failure as McSH and B-type natriuretic peptide(BNP),nesiritide as text words.Their objects,researches methodologies and results were evaluated.Results:A total of 8 clinical RCTs were included.Nesiritide(artificial agent of BNP) averagely reduced PCWP 4.06 mmHg,95%CI[-4.79,-3.33],P< 0.000 01 ,raised cardiac index 0.08 L/min·m~2,95%CI[0.02,0.15],P<0.01;Increased incidence of hypotension,RR=3.36[2.15,5.26],P=0.01;Bradycardia is more often frequent in treatment group,RR=4.99[1.70,14.60],P=0.003,but incidence of ventricular arrhythmia was similar in the both group.Conclusion:Hemodynamics can be improved by BNP in heart failure.Its dosage-relative effects lead to improvement of prognosis in short term duration.BNP can also reduce long-germ mortality of severe CHF in patients with more than 4 risk factors.Although nesiritide can cause side-effect such as hypotension etc.but it is safely toleranted更多还原