左卡尼丁治疗血液透析患者慢性心力衰竭的疗效观察

Effect of L-carnitine in treatment of chronic heart failure in patients undergoing hemodialysis

目的观察左卡尼丁治疗尿毒症维持性血液透析患者慢性心力衰竭的临床疗效。方法选择我院86例慢性肾功能不全(尿毒症期)合并慢性心力衰竭、心功能Ⅲ～Ⅳ级患者,随机分为对照组与观察组。2组均正规血液透析。对照组应用现代心力衰竭治疗模式治疗,治疗组应用现代心力衰竭治疗模式加用左卡尼丁(1 g静脉注射,每周3次,连用3个月)治疗。经3个月规律血液透析治疗后,重新评定心功能分级,并使用彩色多普勒心脏超声检查左室结构和功能。结果 2组心功能分级与治疗前比较差异具有统计学意义(P<0.01),但组间比较,差异无统计学意义(P>0.05),2组左心室舒张末期内径均有明显减少(P<0.05);但对照组室间隔厚度(IVST)、左室后壁舒张末期厚度(LVPwT)和最大血流速度比(E/A)治疗前后比较差异无统计学意义(P>0.05),观察组治疗后IVST、LVPwT明显降低,E/A值显著升高,与治疗前及对照组治疗后比较差异均有统计学意义(P<0.05)。结论左卡尼丁可改善维持性血液透析患者的心功能,安全有效。

Objective To investigate the cardiac protection and application security of L-carnitine in uremia patients with maintenance hemodialysis.Methods 86 cases of chronic renal failure（uremia） associated with chronic heart failure（cardiac function grade Ⅲ ~ Ⅳ） were randomly divided into a control group and a treatment group.The control group patients were treated with standard therapy.The treatment group patients were given L-carnitine（1g intravenous injection,3 times a week for 3months）in addition to standard therapy.3 months’ follow-up was conducted before cardiac function was reassessed and left ventricular structure and function examined by using echocardiography.Results Significant difference（P 0.05） between the control group and the treatment group after 3 months’ blood pressure control and hemodialysis.Left ventricular end-diastolic diameter was reduced（P 0.05） before and after hemodialysis in the control group,while the IVST,LVPwT were significantly reduced（P〈0.05）,and E / A was significantly increased（P〈0.05） in the treatment group after 3 months’ hemodialysis.Conclusion L-carnitine is safe and has a positive protective role in maintenance hemodialysis patients.