bnp-lecture治疗急性心肌梗死心力衰竭.pptxVIP

应用rh-BNP治疗急性心肌梗死心力衰竭心力衰竭治疗新药物、新观点、新视野 (附病例报告); BNP Update ; BNP B-type/Brain natriuretic peptide B型利钠肽即脑利钠肽;BNP首先是由日本学者Sudoh等于1988年从猪脑分离出来而得名，而实际上主要是从心室分泌的一种具有排钠利尿作用的循环激素. ;Five Related Forms of NP ANP (1981): 28-aa peptide, found in the atrium of the heart (Approved drug for heart failure in Japan) 2. BNP (1988， Sudoh): 32-aa peptide, found in the brain and ventricle of heart (Approved drug for heart failure in US, Europe and China) 3. CNP (1990): 22-aa peptide, endothelial origin, found in the lung, kidney and heart 4. DNP (1997): 38-aa peptide, isolated from Dendroaspis angusticeps or green Mamba snake Urodilatin (1988): 32-peptide, is the renal form of ANP (with an NH2 terminal extension of 4 AA residues) and found in the brush border of the kidney;rhBNP,Nisiritide,经临床试验证实，对急 性失代偿性心力衰竭（ADHF）患者有效，已在 2001年被美国食品及药品管理署(FDA)批准应用于 临床，它是近15年来FDA批准的第一个也是唯一一 个可以用于临床治疗ADHF的静脉用药。;but; AMI特别是前壁AMI是临床上最为常见的，对心脏结构和功能最具破坏性的急性病理性损伤过程，而并发心力衰竭后常使冠心病的自然转归发生质的恶化。 早期积极控制心力衰竭的进展，是阻抑左心室急性重构，改善心室功能，降低MACE的重要环节。 目前NIT仍然是临床上治疗AMI-HF较常用的药物选择（这主要是基于其对血流动力学的改善和缓解症状），相比之下，从阻抑AMI后系统性病理损伤的角度上讲，应用rhBNP治疗AMI-HF有着在病理生理学、药理学上的诸多优势。 ;;;Methods ;;;Monitoring of invasive hemodynamic parameters by continues Swan-Ganze catheter ;;; There were no significant differences in SBP between the two groups and as compared to baseline in each group (p0.05);As early as 30 min after the initiation of rhBNP, PCWP was reduced by 48.9% compared to that of baseline this significant change in PCWP continued throughout 24 hours of rhBNP infusion and 6 hours after discontinuing the infusion of rhBNP (P0.05). PCWP reduced significantly at 2 hour of NIT infusion (P0.05) and that returned to baseline values within 6 hour discontinuing the NIT injection. The improvement of PCWP from 30 min to 2 hours of rhBNP infusion were much more marked as compared with that in NIT group (P0.05). There were no significant differences in PCWP between the two gr