左西孟旦、米力农和硝普钠治疗急性心力衰竭的对比研究

目的对比观察左西孟旦、米力农和硝普钠治疗急性心力衰竭（AHF）患者的临床疗效、对神经激素因子水平的影响及安全性。方法90例AHF患者随机分为左西孟旦组、米力农组和硝普钠组，观察三组治疗前后临床疗效，左室舒张末内径（LVIDd）、左室射血分数（LVEF）和短轴缩短率（FS）的变化，血清氨基末端B型利钠肽前体（NT-proBNP）、内皮素-1（ET-1）、去甲肾上腺素（NE）水平及安全性。结果治疗后24h，左西孟旦组较其他两组总有效率高（P=0．004、0．015），左西孟旦组患者临床状况显著改善。治疗后7d，三组LVIDd、LVEF及FS均较治疗前改善（P〈0．01），左西孟旦组LVIDd与其他两组比较未见缩小（P=0．113），而LVEF、FS较其他两组增加（P〈0．01）。治疗后24h及7d，三组血清NT-proBNP水平均较基线水平降低（P〈0．01），治疗后7d较治疗后24h进一步降低（P〈0．01）。治疗后7d，左西孟旦组血清NT-proBNP水平比其他两组降低（P=0．006、0．003）。治疗后7d，三组血清ET-1和NE水平较基线水平降低（P〈0．01），左西孟旦组血清NE比其他两组降低更多（P〈0．017）。随访3个月，左西孟旦组再住院率明显低于其他两组（P=0．005、0．013）。结论左西孟旦能明显改善AHF患者的临床症状，改善心脏收缩功能，降低近期再住院率。

Comparative efficacy of levosimendan, milrinone and sodium nitroprusside in treatment of acute heart failure

Objective To compare the clinical efficacy, neurohormone factors levels and safety of levosi- mendan, milrinone and sodium nitroprusside in patients with acute heart failure（AHF）. Methods 90 patients with AHF were randomized into three therapy groups： levosimendan group, milrinone group and sodium nitroprusside group. The clinical effects, change of left ventricular internal diameter at end-diastole （LVIDd）, left ventricular e- jection fraction （LVEF） and fractional shortening （FS）, B type natriuretic peptide precursor （NT-proBNP）, en- dothelin I （ET-1 ）, norepinephrine （NE） level were observed. Results After 24 hours of treatment, total effective rate was higher in levosimendan group than other two groups（P=0.004,0.015 ）. Patients＂ systemic clinical conditions of levosimendan group were improved markedly. After 7 days of treatment, LVIDd, LVEF and FS were better than baseline（P〈0.01 ） in all of the three groups. In levosimendan group, LVIDd was not signcantly reduced（P=0.113 ）, but LVEF and FS were increased（P〈0.01 ）. In three groups, serum NT-proBNP level decreased after 24 hours and 7 days treatment （P〈0.01）, and was further reduced after 7 days more signicantly than 24 hours（P〈0.01 ）. After 7 days treatment, serum NT-proBNP of levosimendan group was reduced markedly than other groups （P=0.006,0.003）. Serum ET-1 and NE levels of three treatment groups decreased after 7 days compared to 7 days （P〈0.01）. After 7 days treatment, serum NE of levosimendan group reduced moremarkedly than other groups （P〈 0.017）. Followed up three months, in levosimendan group, rehospitalization rate was significantly lower than other groups （P=0.005, 0.013）. Conclusion Levosimendan can significantly improve the clinical symptoms in patients with AHF, gradually improve cardiac systolic function, and reduce rehospitalization rate.