左西孟旦在缺血性心肌病顽固性心力衰竭患者经皮冠状动脉介入治疗中的应用研究

Percutaneous coronary intervention of Levosimendan in ischemic cardiomyopathy patients with refractory heart failure

目的探讨左西孟旦在缺血性心肌病顽固性心力衰竭患者经皮冠状动脉介入治疗中的作用。方法选择我院行介入治疗的80例冠心病慢性心力衰竭患者随机分为治疗组(40例)和对照组(40例)。对照组给予常规药物治疗,治疗组患者在术前2天给予左西孟旦注射液。所有患者均行冠脉造影检查以确定冠脉病变程度、狭窄程度,并行介入治疗。观察术后肌酐水平,随访术后1月心功能改善情况,包括6分钟步行试验、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)等。结果治疗组共完成完全血运重建38例,对照组共完成完全血运重建25例,差异有统计学意义(P<0.05)。术后1月两组患者临床症状均明显减轻;与术前比较,治疗组心功能改善更加明显(P<0.05)。治疗组术后肌酐水平较对照组降低(P<0.05)。结论在对缺血性心肌病顽固性心力衰竭患者,在介入治疗前应用左西孟旦,可增加患者耐受力,从而增加患者完全血运成功率,降低术后并发症的风险,明显改善术后患者心功能及肾功能水平,以最大程度挽救缺血心肌。

Objective To study the effects of levosimendan in ischemic cardiomyopathy patients with refractory heart failure of per -cutaneous coronary intervention .Methods Eighty cases of coronary intervention in patients with chronic heart failure were randomly divided into treatment group （40 cases） and control group （40 cases）.The control group received conventional therapy while treatment group patients were given levosimendan injection two days before surgery .All patients underwent coronary angiography to determine the extent of coronary artery disease and the degree of stenosis ,and received intervention .Postoperative creatinine levels were observed , and heart function situation was followed up,including the 6-minute walk test,left ventricular end-diastolic diameter （LVEDD）,left ventric-ular ejection fraction （LVEF）, etc.Results Treatment group completed a total of 38 cases of complete revascularization,while the control group completed a total of 25cases of complete revascularization with the difference statistically significant （P〈0.05）.Clinical symptoms significantly reduced in the control and treatment group .Treatment group improved heart function more obviously than that before the operation （ P〈0.05 ） .Creatinine level after the operation in treatment group was lower than that in control group （ P〈0.05）.Conclusion Ischemic cardiomyopathy refractory heart failure patients injected levosimendan before the intervention increased their tolerance ,increased the success rate of complete blood flow ,reduced the risk of postoperative complications ,improved significantly postoperative cardiac function and renal function levels to save ischemic myocardium to an extreme degree .