目的 评价大剂量重组人B型利钠肽(recombinant human B-type natriuretic peptide，rhBNP)治疗心力衰竭的疗效。方法 将50例急性难治性心力衰竭患者随机分为小剂量组(n=23)和大剂量组(n=27)。按照1.5 μg/kg的负荷剂量静脉注射后，小剂量组以0.01 μg(kg·min)持续静脉滴注48～72 h，大剂量组以0.03 μg/(kg·min)持续静脉滴注24 h，之后以0.015 μg /(kg·min)持续静脉滴注24～48 h。分析两组患者的临床症状改善情况、尿量、血肌酐、NT-proBNP的变化值、30 d的病死率和再入院率。结果 大剂量组患者在24 h、48 h症状改善、尿量的增加和NT-proBNP的变化值方面优于小剂量组(P＜0.05)，而7 d症状改善、血肌酐变化值、30 d病死率和再入院率差异无统计学意义。结论 大剂量rhBNP可以更快地改善患者的症状，增加尿量，降低NT-proBNP，但对肾功能、病死率、再住院率影响不大。

Objective To investigate the curative effect of large doses of recombinant human B-type natriuretic peptide(rhBNP)on acute refractory heart failure. Methods 50 patients with acute severe refractory heart failure were randomly divided into two groups and treated with priming loading dose of 1.5 μg/kg intravenous injection of rhBNP, and then 23 patients in low doses group maintained the therapy for 48 to 72 hours with the speed of 0.01 μg/(kg·min),while 27 patients in high doses group maintained the therapy for 24 hours with the speed of 0.03 μg/(kg·min) and following dose of 0.015 g/(kg·min)for continuous 24 to 48 hours.The changes of clinical symptoms and physical signs in both groups were observed,and the changes of urinary volume during 24 hours,renal function,NT-proBNP in both groups were recorded,30 d mortality and rehospitalization rates were also recorded. Reaults The high doses group had a more significant improvement of clinical symptoms during 24-48 hours, urinary volume, and NT-proBNP than the other one (P＜0.05).The clinical symptoms in 7 days,the change of creatinine, mortality and rehospitalization rates had no differences between the two groups(P＞0.05). Conclusions Intravenous injection of large doses rhBNP improves clinical symptoms, urinary volume and NT-proBNP,but has no effect on renal function, mortality and rehospitalization rates.