左西孟旦对左室心肌致密化不全致难治性心力衰竭的疗效观察

摘要： 目的 评价左西孟旦对左室心肌致密化不全致难治性心力衰竭的疗效。方法 收集天津市胸科医院 2016年1月—2017年12月心脏重症病区收治的难治性心力衰竭患者122例， 根据心衰发病原因分为左室心肌致密化不全 （LVNC） 组6例、 缺血性心肌病 （ICM） 组91例和扩张型心肌病 （DCM） 组25例。所有患者均在常规治疗效果不佳的基础上使用左西孟旦静脉持续泵入24 h， 比较所有患者在左西孟旦使用前和使用完毕后48 h的实验室和超声指标。结果 与用药前相比， 输注左西孟旦结束后48 h， LVNC组左室舒张末径 （LVEDD）、 左室射血分数 （LVEF）、 肺动脉收缩压 （PASP）、 N端前脑钠肽 （NTproBNP） 无明显改善 （P＞0.05）， ICM组LVEDD、 LVEF、 PASP和NTproBNP均得到改善（P＜0.01）， DCM组LVEF和NTproBNP得到改善（P＜0.01）。应用左西孟旦48 h后， ICM组LVEDD、 LVEF、 NTproBNP、 PASP的改善程度较LVNC组更显著 （P＜0.05）， DCM组LVEF和NTproBNP的改善程度较LVNC组更显著（P＜0.05）。结论 左西孟旦对心肌致密化不全所致难治性心力衰竭疗效差， 该药可能不适用于该类患者。

Clinical effects of levosimendan on refractory heart failure caused by left ventricular myocardial insufficiency

Abstract: Objective To report our experience with levosimendan in refractory heart failure caused by left ventricular noncompaction. Methods A total of 122 patients with refractory heart failure were collected in the cardiac intensive care unit of Tianjin Chest Hospital from January 2016 to December 2017. According to the causes of heart failure, the patients were divided into three groups including left ventricular noncompaction group (LVNC, n=6), ischemic cardiomyopathy group (ICM, n=91) and dilated cardiomyopathy group (DCM, n=25). All patient received continuous infusion of levosimendan for 24 hours on the basis of the failure of conventional treatment. The biological and echocardiographic data before and after 48 hours of levosimendan administration were analyzed and compared between three groups. Results Compared with data before administration, there were no significant improvement in the left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP) and N-terminal pro-brain natriuretic peptide (NTproBNP) after 48 hours of levosimendan infusion in LVNC group (P＞0.05). The LVEDD, LVEF, PASP and NTproBNP were all improved in ICM group (P＜0.01). And LVEF and NTproBNP were improved in DCM group (P＜0.01). After 48 hours of levosimendan administration, the improvement of LVEDD, LVEF, NTproBNP and PASP was more significant in ICM group than that in LVNC group (P＜0.05), and the improvement of LVEF and NTproBNP was more significant in DCM group than that in LVNC group (P＜0.05). Conclusion Levosimendan has poor efficacy in refractory heart failure caused by left ventricular noncompaction, and it may not be suitable for this type of patients.