左卡尼汀辅助治疗维持性血液透析患者合并慢性心力衰竭临床疗效观察

Clinical effect of adjunctive therapy with Levocarnitien on patients combined with chronic heart failure treated by maintenance hemodialysis

目的观察左卡尼汀辅助治疗维持性血液透析患者合并慢性心力衰竭的疗效。方法选择合并有慢性心力衰竭、心功能Ⅲ级或Ⅳ级的维持性血液透析患者40例,随机分为治疗组和对照组临床,每组20例,所有患者均按照终末期肾病(ESRD)常规处理(降压、扩血管、纠正贫血、改善钙磷代谢紊乱、强心等治疗)。每周血液透析3次,每次4小时。治疗组每次血液透析后将左卡尼汀1g稀释于生理盐水20ml中缓慢静脉注射,对照组静脉注射生理盐水20ml,治疗16周后,比较两组患者治疗前后心功能分级变化情况及左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)变化情况。结果治疗组患者治疗16周后心功能普遍改善1～2级,显效率40%,总有效率85%;而对照组显效率为15%,总有效率为50%,两组比较有统计学差异(P<0.05);治疗后治疗组较对照组LVEF上升,LVEDD缩小,两组比较有统计学差异(P<0.05)。结论维持性血液透析患者合并慢性心力衰竭经左卡尼汀辅助治疗能够防止和减轻心室重构,改善心功能,提高维持性血液透析患者的生活质量。

Objective To observe the effect of adjunctive therapy with levocarnitien on the patients combined with chronic heart failure treated by maintenance hemodialysis.Methods 40 patients who were treated with maintenance hemodialysis combined with chronic heart failure,with a heart function of grade III or IV were randomly divided into treatment group and control group,each with 20 cases.All patients were treated routinely as end stage renal diseases（ESRD）,including depressurization,distension of the blood vessels,rectification of anemia,improve the disorders of calcium and phosphorus metabolism as well as enhancement of heart function,et al.The patients were treated with hemodialysis 3 times a week,4 hours each time.After hemodialysis,1g levocarnitien was diluted into 20 ml saline and employed for the patients of the treatment group via intravenous injection slowly,while 20 ml saline only was used for the patients of the control group with the same method.16 weeks later with such treatment,grade of heart function,left ventricular ejection fraction（LVEF）,and left ventricular end diastolic dimension（LVEDD） before and after treatment in all of the patients from the two groups were compared.Results Heart function of the patients from the treatment group were improved 1 to 2 grade after treatment,excellence rate reached a level of 40% with a total effective rate of 85%,while the excellence rate and total effective rate of the control group were only 15% and 50%.A statistically significant difference could be found between the two groups（p 0.05）.When compared with those before treatment,LVEF increased while LVEDD decreased obviously with statistically significant differences be found between the two groups（P0.05）.Conclusion Adjunctive levocarnitien treatment in patients combined with chronic heart failure treated by maintenance hemodialysis can effectively prevent and mitigate ventricular reconstitution,improve heart function,and improve the quality of life in the patients treat by maintenance hemodialysis.