左西孟旦治疗慢性心力衰竭急性失代偿患者的临床观察

Clinical observation of levosimendan on patients with acute decompensated heart failure

目的:观察左西孟旦治疗慢性心力衰竭急性失代偿患者的临床效果及安全性。方法:符合纳入标准的100例慢性心力衰竭急性失代偿患者被随机分成左西孟旦组和米力农组。观察两组治疗前后的临床疗效、心功能,测定B型利钠肽(BNP)、24 h尿量、收缩压(SBP)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)等指标,观察两组的不良反应。结果:左西孟旦组显效率和总有效率均高于米力农组(χ2分别为4.006和8.274,P<0.05);两组治疗后BNP,24 h尿量,LVEF与治疗前比较差异有统计学意义(P<0.01),左西孟旦治疗在降低BNP,增加24 h尿量,改善LVEF方面均显著优于米力农(P<0.01);左西孟旦组不良反应发生率(12%)显著低于米力农组(22%),差异有统计学意义(χ2=1.301,P<0.05)。结论:左西孟旦治疗顽固性慢性心力衰竭急性失代偿患者,可明显改善血流动力学指标,提高心功能,从而改善心力衰竭的症状且安全、有效。

Objective： To explore the clinical efficacy and safety of levosimendan on patients with acute decompensated heart failure. Methods： One hundred patients met the inclusion criteria were randomly di- vided into one group with levosimendan and the other group with milrinone. Clinical efficacy, heart func- tion, BNP and the 24 hourly urine volume, systolic pressure, LVEF, LVEDD and adverse reaction were de- tected before and after treatment. Results： Both efficiency and total effective rate after treatment in levosi- mendan group were higher than those in milrinone group （X2 = 4. 006 and 8. 274, P 〈 0.05 ）. Statistical sig- nificance of BNP, the 24 hourly urine volume and LVEF was noted in two groups after treatment （P 〈 0.01 ）. Serum BNP levels decreased, the total 24 hourly urine volume increased and LVEF improved in le- vosimendan group compared with milrinone group（P 〈 0.01 ）. During the treatment period, occurrences of adverse events in levosimendan group were lower than those in control group （X^2 - 1. 301 ,P 〈0.05 ）. Con- clusion： Levosimendan was well tolerated and superior to milrinone for patients with decompensated heart failure refractory to conventional medications, because it was able to improve heart function and the symp- toms of heart failure by alterring haemodynamic variables.