间歇性使用左西孟旦治疗难治性心力衰竭的临床研究

目的观察间歇性使用左西孟旦治疗难治性心力衰竭的临床疗效及安全性。方法选取2014年1月—2015年12月首都医科大学宣武医院收治的难治性心力衰竭患者108例,按随机数字表分为对照组、左西孟旦1周组和左西孟旦2周组,每组各36例。对照组患者给予抗心力衰竭基础治疗,包括血管扩张剂、利尿剂、醛固酮受体阻滞剂及血管紧张素转换酶抑制剂、传统正性肌力药物洋地黄等。左西孟旦1周组在对照组基础上于治疗第1天给予左西孟旦注射液12μg/kg,iv 10 min后改为静脉滴注,速度为0.1μg/(kg·min),滴注1 h后如果没有出现严重低血压,将滴注速度上调为0.2μg/(kg·min),继续滴注23 h。左西孟旦2周组在对照组基础上于治疗第1天及第8天给予左西孟旦注射液,具体用法同左西孟旦1周组。3组连续治疗14 d。观察3组的临床疗效,比较3组治疗前后的心功能指标和血流动力学参数。结果治疗后,对照组、左西孟旦1周组及2周组的总有效率分别为55.6%、77.8%、94.4%,3组比较差异有统计学意义(P0.05);且左西孟旦2周组的总有效率优于左西孟旦1周组,两组比较差异有统计学意义(P0.05)。治疗后,3组患者的左心室射血分数(LVEF)均明显升高,而收缩压(SBP)、心率(HR)及N-末端前体脑钠肽(NT-pro BNP)均明显降低,同组治疗前后差异有统计学意义(P0.05);左西孟旦1周组及2周组这些观察指标改善程度明显优于对照组(P0.05);且左西孟旦2周组这些观察改善程度还明显优于左西孟旦1周组,两组比较差异有统计学意义(P0.05)。治疗后,3组患者的心指数(CI)均明显升高,而MPAP(平均肺动脉压)、SVR(体循环阻力)、PCWP(肺毛细血管楔压)均明显降低,同组治疗前后差异有统计学意义(P0.05);左西孟旦1周组及2周组这些观察指标改善程度明显优于对照组(P0.05);且左西孟旦2周组这些观察改善程度还明显优于左西孟旦1周组,两组比较差异有统计学意义(P0.05)。结论间歇性使用左西孟旦治疗难治性心力衰竭具有较好的临床疗效,能改善心脏功能和血流动力学,具有一定的临床推广应用价值。

Clinical study on the intermittently administering with levosimendan in treatment of refractory heart failure

Objective To investigate the clinical effect of the intermittently administering with levosimendan in treatment of refractory heart failure.Methods Patients (108 cases) with refractory heart failure in Xuanwu Hospital Capital Medical University from January 2014 to December 2015 were divided into the control, levosimendan group for 1 week, and levosimendan group for 2 weeks, and each group had 36 cases. Patients in the control group were given the basic treatment of heart failure, including vascular expansion agent, diuretic, aldosterone receptor blockers and angiotensin converting enzyme inhibitors, traditional positive inotropic drugs such as digitalis. Patient in the levosimendan group for 1 week were iv administered with Levosimendan Injection on the basis of the control group at the first day of treatment, 12μg/kg, iv for 10 min, and the method of administration were adjusted to intravenous drip of 0.1μg/(kg·min) for 1 h, then drip rate were adjusted to 0.2μg/(kg·min) for 23 h. Patients in the levosimendan group for 2 week were iv administered with Levosimendan Injection on the basis of the control group at the first and eighth day of treatment, and the method of administration was the same as levosimendan group for 1 week. Patients in three groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and heart function indexes and hemodynamic parameters in three groups were compared.Results After treatment, the clinical efficacies in the control, levosimendan group for 1 week, and levosimendan group for 2 weeks were 55.6%,77.8% and 94.4%, respectively, and there was difference among three groups (P < 0.05). And the clinical efficacy in the levosimendan group for 2 weeks was better than that in the levosimendan group for 1 week, with significant difference between two groups (P<0.05). After treatment, the LVEF in three groups were significantly increased, but SBP, HR and NT-proBNP in three groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the levosimendan group for 1 week and levosimendan group for 2 weeks were significantly better than those in the control group, with significant difference between two groups (P<0.05). And the observational indexes in the levosimendan group for 2 weeks was better than that in the levosimendan group for 1 week, with significant difference between two groups (P<0.05). After treatment, the CI in three groups was significantly increased, but MPAP, SVR, and PCWP in three groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the levosimendan group for 1 week and levosimendan group for 2 weeks were significantly better than those in the control group, with significant difference between two groups (P<0.05). And the observational indexes in the levosimendan group for 2 weeks was better than that in the levosimendan group for 1 week, with significant difference between two groups (P<0.05).Conclusion The intermittently administering with levosimendan has the clinical curative effect in treatment of refractory heart failure, and can improve heart function and hemodynamic function, which has a certain clinical application value.