OBJECTIVE： To observe therapeutic efficacy and safety of recombinant human brain natriuretic peptide （rhBNP） in the treatment of acute decompensated heart failure （ADHF）. METHODS： 129 ADHF patients admitted in our hospital during Jul. 2013-Jul. 2015 were randomly divided into observation group （69 cases） and control group （60 cases）. Control group was given routine treatment. Observation group was additionally given rhBNP 1.5 μg/（kg·d）vein shock （d1）， and then rhBNP 1 mg+5％ Glucose injection 100 ml by 0.007 5 μg/（kg·min）， ivgtt （d2-4）. Treatment courses of 2 groups lasted for 7 d. Therapeutic efficacy and heart function indexes [left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVDd）] were observed in 2 groups as well as NT-proBNP level， medication fluid intake and urine volume 24 h after medication. The occurrence of ADR was observed. RESULTS：  3 cases dropped out and 66 cases were included finally in doservation group. Total effective rate of ADHF therapy in observation group （96.97％） was significantly higher than in control group （86.67％）， with statistical significance （P＜0.05）. There was no statistical significance in LVEF，LVDd and NT-proBNP between 2 groups before treatment （P＞0.05）. After treatment， LVEF of 2 groups were increased significantly while LVDd were decreased significantly； LVEF of observation group [（42.3±3.6）％] was significantly higher than in control group[（37.9±3.3）％]，while LVDd of observation group [（55.5±3.6）％] was significantly lower than in control group[（61.3±3.4）％]. NT-proBNP levels of 2 groups were decreased significantly， and the observation group [（1 389.5±29.6）pg/ml] was significantly lower than the control group [（2 778.0±26.8）pg/ml]. 24 h after medication， urine volume of 2 groups were significantly higher than medication fluid intake， and urine volume of observation group [（1 781.4±89.7）ml] was significantly higher than that of control group [（1 372.6±78.3）ml]， with statistical significance （P＜0.05）. There was no statistical significance in the incidence of ADR between observation group （3.03％） and control group （5.00％）， without statistical significance （P＞0.05）. CONCLUSIONS： rhBNP is significantly effective for ADHF， promotes heart function recovery and reduces renal function injury with good safety.