门诊间歇输注左西孟旦对晚期心力衰竭患者的疗效及安全性

Efficacy and Safety of Intermittent Infusion of Levosimendan in Outpatients with Advanced Heart Failure

随着医疗水平的提高及人口老龄化,晚期心力衰竭患者越来越多。晚期心力衰竭患者生活质量差,死亡率高,常因急性失代偿或症状恶化需反复住院,给患者、家庭、社会带来严重的经济负担,占用了大量的医疗资源。虽然先进疗法如心脏移植和左心室辅助装置的使用确实使患者寿命延长、生活质量明显改善,但由于各种因素(经济、供体、患者合并症、不符合先进疗法的适应证等),这些治疗方法仅使极少部分患者获益。因此,大多数患者还是使用药物进行姑息治疗。间歇输注正性肌力药物可以改善血流动力学、减轻心力衰竭症状、改善生活质量,被认为是一种可行的方法,然而,传统的正性肌力药物安全性较差。左西孟旦是具有独特作用机制及药代学特点的新型钙增敏剂,主要用于急性心力衰竭,随着人们研究的深入,其临床适应证已逐渐扩大。目前许多学者建议对晚期心力衰竭患者间歇输注左西孟旦以预防患者因心力衰竭急性失代偿而频繁住院及改善症状,尤其在门诊情况下。本文就该方面的研究做一综述,以期帮助临床了解其有效性及安全性。

With the improvement of medical standards and the aging of the population,there are more and more patients with advanced heart failure.Patients with advanced heart failure have poor quality of life and high mortality.They often require repeated hospitalizations due to acute decompensation or worsening symptoms,which brings serious economic burdens to patients,families,and society,and takes up a lot of medical resources.Although advanced therapies such as heart transplantation and the left ventricular assist devices do prolong the life of patients and significantly improve the quality of life,due to various factors(economy,donors,patients’comorbidities,indications that are not in line with advanced therapies,etc.),these therapies benefit only a few patients.Therefore,most patients still use drugs for palliative care.Intermittent infusion of inotropic drugs can improve hemodynamics,relieve symptoms and improve quality of life,and is considered a feasible METhod.However,traditional inotropic drugs are less safe.Levosimendan is a new calcium sensitizer with unique mechanism of action and pharmacokinetic characteristics.It is mainly used for acute heart failure.With people’s in-depth research,clinical indications have gradually expanded.Many scholars recommend intermittent infusion of levosimendan in patients with advanced heart failure to prevent acute decompensation of heart failure and frequent hospitalization and improve symptoms,especially in outpatient setting.This article reviews the studies in this area to help understand its efficacy and safety.