左西孟旦静脉负荷与非负荷给药治疗难治性心力衰竭的临床观察

目的探讨左西孟旦负荷与非负荷给药方式的临床疗效。方法难治性心力衰竭患者40例,随机分为两组,每组20例,两组患者的基本情况、呼吸困难程度、左室射血分数（EF）、脑钠肽（BNP）水平无显著差异。两组均给予常规抗心力衰竭治疗;在此基础上随机给予左西孟旦负荷或非负荷治疗。左西孟旦负荷组：负荷剂量6~12μg/kg,负荷给药时间〉10 min,之后持续静脉输注0.1μg/（kg·min）;左西孟旦非负荷组：8.7μg/min速度匀速泵入,维持24 h。观察两组患者用药前后的呼吸困难程度、EF、BNP、血压、心率、心律、肝肾功能变化。并对过程中所有不良事件进行记录。结果用药后两组患者的呼吸困难程度、全身临床状况、BNP、EF值均较用药前改善,且两组治疗后BNP降低、EF值提高的程度无统计学差异。用药后30 min负荷组的呼吸困难好转程度优于非负荷组（P=0.01）,给药6、24、72 h后两组呼吸困难好转程度无明显差异。负荷组用药后30 min的收缩压及舒张压均低于非负荷组（P=0.04和0.01）,有统计学差异。结论左西孟旦能有效改善难治性心力衰竭患者的血流动力学和呼吸困难程度,降低BNP,提高EF值。左西孟旦非负荷给药与负荷给药治疗难治性心力衰竭的临床疗效相当,简便、安全、可靠。

Clinical observation of levosimendan in the treatment of refractory congestive heart failure

Objective To evaluate the efficacy of loading or non loading administration of levosimendan in the treatment of patients with refractory congestive heart failure（RCHF）.Methods A randomized,open,control clinical trial was conducted in 40 patients with RCHF.Besides regular treatment,patients in test group（n = 20） were given levosimendan injection with initial loading dose of 6-12 μg/kg for 10 min,followed by a continuous infusion of 0.1 μg/（kg·min）.While in control group（n = 20）,patients were given Levosimendan injection with a continuous infusion of 8.7 μg/min for 24 h.Dyspnea,eject fraction（EF）,BNP level,blood pressure,heart rate,rhythm of the heart,the function of liver and kidney before and after drug administration were examined.All adverse events during the process were recorded.Results The base line showed there was no significant difference between the 2 groups.Dyspnea degree,general clinical condition,BNP,EF values were all improved,compared with those in patients before treatment.After 30 min of administration,in test group improved dyspnea,decreased systolic and diastolic blood pressure were more greatly than those in control group（P = 0.04 and 0.01,respectively）.However there were no significant differences of dyspnea degree,decreased BNP,between the 2 groups after administration of 6 h,24 h,and 72 h.In addition,there was no significant difference in enhanced EF value at 24 h,72 h between the 2 groups.Conclusion Levosimendan was effective in treating RCHF and could improve hemodynamic,degree of dyspnea and decrease BNP,increase EF value.Compared with loading group,non loading administration of levosimendan in the treatment of RCHF was equivalent,safe,and more convenient.