左西孟旦治疗心肌梗死后心源性休克的临床研究

目的探讨左西孟旦注射液治疗心肌梗死后心源性休克的临床疗效。方法选取2015年1月—2016年7月在秦皇岛市第一医院心血管内科治疗的急性心肌梗死后心源性休克患者60例,按照数字随机法将所有患者随机分为对照组和治疗组,每组各30例。对照组静脉泵注盐酸多巴酚丁胺注射液,初始剂量2μg/(kg·min),1 h后增至4μg/(kg·min),持续给药24 h。治疗组静脉泵注左西孟旦注射液,初始剂量12μg/(kg·min),1 h后剂量调整为0.5μg/(kg·min),持续给药24 h。两组患者均治疗7 d。观察两组的临床疗效,比较两组的心功能、高敏C反应蛋白(hs-CRP)、白细胞介素-8(IL-8)、肿瘤坏死因子α(TNF-α)和N-末端脑钠肽前体(NT-pro BNP),以及胸痛发作12、36 h的血清肌酸激酶同工酶(CK-MB)和肌钙蛋白I(c TNI)的情况。结果治疗后,对照组和治疗组的总有效率分别为73.33%、93.33%,两组比较差异有统计学意义(P0.05)。治疗后,两组左室收缩末期内径(LVESD)和左室舒张末期内径(LVEDD)均显著降低,而左室射血分数(LVEF)均显著升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组hs-CRP、IL-8、TNF-α和NT-pro BNP水平均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。胸痛发作36 h,两组CK-MB和c TNI均显著低于胸痛发作12 h,同组比较差异有统计学意义(P0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论左西孟旦注射液治疗心肌梗死后心源性休克具有较好的临床疗效,能改善心功能,调节hs-CRP、IL-8、TNF-α和NT-pro BNP水平,具有一定的临床推广应用价值。

Clinical study on levosimendan in treatment of cardiogenic shock after myocardial infarction

Objective To evaluate the clinical effect of Levosimendan Injection in treatment of cardiogenic shock after myocardial infarction. Methods Patients (60 cases) with cardiogenic shock after myocardial infarction in Department of Cardiovascular Medicine of First Hospital of Qinhuangdao from January 2015 to July 2016 were randomly divided into control and treatment groups, and each group had 30 cases. Patients in the control group were intravenous pump injection administered with Dobutamine Hydrochloride Injection, initial dosage was 2 μg/(kg·min), increased to 4 μg/(kg·min) after 1 h, continued administration of 24 h. Patients in the treatment group were intravenous pump injection administered with Levosimendan Injection, initial dosage was 12μg/(kg·min), adjusted to 0.5 μg/(kg·min) after 1 h, continued administration of 24 h. Patients in two groups were treated for 7 d. After treatment, the clinical efficacies were evaluated, and heart function, hs-CRP, IL-8, TNF-α, NT-proBNP, and the levels of serum CK-MB and cTNI at 12 and 36 h after chest pain attack in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 73.33% and 93.33%, respectively, and there was difference between two groups (P < 0.05). After treatment, LVESD and LVEDD in two groups were significantly decreased, but the LVEF in two groups were significantly increased,and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the levels of hs-CRP, IL-8, TNF-α, and NT-proBNP in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). The levels of serum CK-MB and cTNI at 36 h after chest pain attack in two groups were lower than those at 12 h after chest pain attack in two groups, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Levosimendan Injection has clinical curative effect in treatment of cardiogenic shock after myocardial infarction, can improve heart function, and regulate levels of hs-CRP, IL-8, TNF-α, and NT-proBNP, which has a certain clinical application value.