左西孟旦对顽固性心力衰竭患者心功能的影响

摘要

Objective To observe the clinical effect of Levosimendan for treatment of patients with refractory heart failure in order to provide a reference for doctors treating this disease. Methods One hundred and eighty patients with refractory heart failure were admitted to Tongde Hospital of Zhejiang Province from February 2014 to December 2017, and they were divided into two groups by random number table method: a western medicine routine treatment group (western control group) and a Levosimendan group, each group 90 cases. The patients in western control group were given conventional anti-cardiac failure drugs ; and those in Levosimendan group were treated with the therapies as above group, and additionally Levosimendan continuous intravenous infusion for 24 hours was given. The clinical efficacy of the two groups was evaluated after 3 days of treatment. After treatment, the differences of ejection fraction (EF), stroke volume (SV), end-systolic volume (ESV), end-diastolic volume (EDV) and the levels of N-terminal brain natriuretic peptide precursor (NT-proBNP) and cardiac troponin I (cTnI) were compared between the two groups. Results After treatment, the EF and SV levels were significantly increased, while the ESV, EDV, NT-proBNP and cTnI levels were decreased obviously compared with those before treatment in the two groups (all P <0.05); the changes of the levels of EF, SV and NT-proBNP and cTnI of Levosimendan group were more significant than those of the western control group [EF: 0.49±0.06 vs. 0.44±0.06, SV (mL): 86.54±17.63 vs. 81.48±18.46, NT-proBNP (μg/L): 5.50±1.28 vs. 6.64±1.54, cTnI (μg/L): 0.08±0.01 vs. 0.14±0.13, all P < 0.05], while there were no significant differences of the levels of ESV and EDV between the two groups [ESV (mL): 111.56±32.53 vs. 128.76±32.13, EDV (mL): 187.95±39.28 vs. 185.06±41.23, both P > 0.05]. The total effective rate of the Levosimendan group was obviously higher than that of the western control group [97.78% (88/90) vs. 78.89% (71/90), P < 0.05]. Conclusion Levosimendan can effectively improve the hemodynamics in patients with refractory heart failure, the elevation of patients' heart function, and the short-term therapeutic effect is very remarkable.%目的 观察左西孟旦治疗顽固性心力衰竭(心衰)的临床疗效,以期为顽固性心衰的治疗提供参考.方法 选择2014年2月至2017年12月浙江省立同德医院收治的顽固性心衰患者180例,将患者按随机数字表法分为西医常规治疗组和左西孟旦组,每组90例.西医常规治疗组给予常规抗心衰药物;左西孟旦组在西医常规治疗基础上加用左西孟旦注射液,24 h持续静脉滴注(静滴).两组均治疗3 d后评价其临床疗效.比较两组治疗后射血分数(EF)、每搏量(SV)、收缩期末容积(ESV)、舒张期末容积(EDV)和N末端B型钠尿肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)水平的差异.结果 两组治疗后EF、SV均较治疗前显著升高,而ESV、EDV和NT-proBNP、cTnI水平均较治疗前显著下降(均P＜0.05);且治疗后左西孟旦组EF、SV和NT-proBNP、cTnI水平的变化较西医常规治疗组更显著〔EF :0.49±0.06比0.44±0.06,SV(mL):86.54±17.63比81.48±18.46,NT-proBNP(μg/L):5.50±1.28比6.64±1.54,cTnI(μg/L):0.08±0.01比0.14±0.13,均P＜0.05〕;左西孟旦组和西医常规治疗组ESV、EDV比较差异均无统计学意义〔ESV(mL):111.56±32.53比128.76±32.13,EDV(mL):187.95±39.28比185.06±41.23,均P＞0.05〕.左西孟旦组治疗后总有效率显著高于西医常规治疗组〔97.78%(88/90)比78.89%(71/90),P＜0.05〕.结论 左西孟旦能有效改善顽固性心衰患者的血流动力学,提高患者心功能,短期疗效显著.