左西孟旦治疗重度失代偿性心力衰竭的临床观察

目的:评价对常规药物治疗疗效不佳的重度失代偿性心力衰竭患者静脉注射左西孟旦的有效性及安全性。方法:80例心力衰竭患者,对照组(40例,常规药物治疗+米力农注射液),米力农注射液初始负荷量为25μg·kg-1,注射时间10min,随即以0.25μg·kg-1·min-1静脉滴注,1h后增加到0.5μg·kg-1·min-1并持续23h,上述治疗共2次(48h);试验组(40例,常规药物治疗+左西孟旦注射液),左西孟旦注射液初始负荷量为12μg·kg-1,注射时间10min,随即以0.1μg·kg-1·min-1静脉滴注,1h后增加到0.2μg·kg-1·min-1并持续23h,上述治疗共2次(48h)。治疗48h后比较2组的临床有效率、左心室射血分数(LVEF)和每搏心输出量(SV),综合评价药物的疗效和安全性。结果:治疗48h后,试验组临床有效率为32.5%(13/40),对照组临床有效率为17.5%(7/40)(P<0.01);试验组与对照组的左心室射血分数(LVEF)上升均值分别为6.4%、4.5%(P>0.05),每搏心输出量(SV)上升均值分别为11.1、2.8mL(P<0.05);试验组患者呼吸困难和全身临床状况显著改善。2组均未发生严重不良事件,试验组不良反应发生率(12.5%)显著低于对照组(22.5%)(P<0.05),常见的不良反应为低血钾、低血压以及室性早搏。结论:与米力农比较,左西孟旦注射液治疗重度失代偿性心力衰竭疗效确切,安全性及患者耐受性良好。

Clinical Observation of Levosimendan in the Treatment of Severe Decompensated Heart Failure

OBJECTIVE：To evaluate the efficacy and safety of intravenous injection of levosimendan in the treatment of patients with severe decompensated heart failure who has no good response to conventional drugs.METHODS：80 patients with heart failure were randomly divided into 2 groups.Control group （40 cases,conventional treatment＋Milrinone injection） were given Milrinone injection with initial loading dose of 25 μg·kg-1 for 10 min,followed by a continuous infusion of 0.25 μg·kg-1·min-1 for 1 h and then 0.5 μg·kg-1·min-1 for 23 h.The treatment was repeated in the next 24 hours.Trial group （40 cases,conventional treatment＋Levosimendan injection） were given Levosimendan injection with an initial loading dose of 12 μg·kg-1 for 10 min,followed by a continuous infusion of 0.1 μg·kg-1·min-1 for 1 h and then 0.2 μg·kg-1·min-1 for 23 h.The treatment was also repeated in the next 24 hours.Clinical effective rate,LVEF,SV,therapeutic efficacy and safety of 2 groups were evaluated after 48 h.RESULTS：After 48 h,effective rate of trial group was 32.5% （13/40） and that of control group was 17.5% （7/40） （P0.01）.At 48 h,left ventricular ejection fraction （LVEF） was improved by 6.4% in trial group and 4.5% in control group （P0.05）.Stroke volume （SV） was increased by 11.1 mL in trial group and 2.8 mL in control group respectively （P0.05）.Dyspnea and systematic symptom of trial group had been improved significantly.No severe adverse drug reaction （ADR） had been found in two groups.The incidence of ADR in trial group （12.5%） was significantly lower than that of control group （22.5%） （P0.05）.Common ADR were hypokalemia,hypotension and ventricular premature beats.CONCLUSION：Levosimendan is well tolerated,safe and superior to milrinone for patients with severe decompensated heart failure.