左西孟旦治疗难治性充血性心力衰竭的近期疗效观察

目的 评价左西孟旦治疗难治性充血性心力衰竭（CHF）的疗效.方法 将100例CHF患者随机分为治疗组（50例）和对照组（50例）.对照组给予洋地黄、血管紧张素转换酶抑制剂（ACEI）、螺内酯、多巴酚丁胺、米力龙等综合治疗;治疗组在对照组治疗基础上,改多巴酚丁胺为左西孟旦.观察两组治疗前后血压、心率,超声心动图测定心功能指标的变化,静脉置Swan-Ganz导管,以心电压力监测仪测定平均右房压（MRAP）、平均肺动脉压（MPAP）和平均肺毛细血管楔压（MPCWP）,热稀释心排计算机测定心排血量,计算心脏指数（CI）、左室搏动指数（LVgWI）、体循环阻力（SvR）和肺循环阻力（PvR）.结果 治疗组左室射血分数与对照组相比明显改善（48±4）%比（42±4）%,P＜0.05）],血压及心率下降程度、6 min步行距离,以及左心室内径缩短程度、相对室壁厚度（RWT）、短轴缩短率（FS）、心搏出量（SV）增加程度均显著优于对照组（P＜0.05）;MRAP、MPAP、MPCWP、LVgWI、SvR、PvR,MPAP、MPCwP下降,CI增加,SVR、PVR降低,与对照组比较差异有统计学意义（P＜0.05）.结论 左西孟旦能够更好地增加左室射血分数,改善心功能.

Effects of Levosimendan in the treatment of refractory congestive heart failure

Objective To evaluate Levosimendan for the treatment of refractory congestive heart failure efficacy and safety. Methods 100 cases of CHF were randomly divided into the treatment group （50 cases） and control group （50 cases）, and control group was treated with digitalis, angiotensin converting enzyme inhibitors （ACEI）, spironolactone, dobutamine, milrinone therapy; treatment group in the control group based on modified treatment, dobutamine Levosimendan. Blood pressure and heart rate were observed before and after treatment, ultrasonic heartbeat diagram determination indexes of cardiac function changes and venous indwelling catheter in Swan Ganz, ECG pressure monitor determination of mean right atrial pressure （MRAP）, mean pulmonary arterial pressure （MPAP）, mean pulmonary capillary wedge pressure （MPCWP）, thermal dilution cardiac output computer determination of cardiac output, the calculation of cardiac index （CI）, left ventricular pulsatility index （LVgWI）, systemic vascular resistance （SvR）, pulmonary vascular resistance （PvR）. Results The left ventricular ejection fraction in treatment group compared with the control group was improved significantly （48＋4）% vs（42＋4）%（P〈 0.05）, the decrease degree of blood pressure and heart rate, increase degree of 6 min walking distance, as well as left ventricular diameter shortening, relative wall thickness （RWT）, fractional shortening （FS）, cardiac output （SV） were significantly better than the control group （P〈0.05）, decreases of MRAP, MPAP, MPCWP, LVgWI, SvR, PvR, MPAP, MPCwP, increase of CI and decreases of SVR, PVR were significantly differences with control group （P〈0.05）. Conclusion Levosimendan can increase the left ventricular ejection fraction, and improve heart function.