左西孟旦对失代偿性心力衰竭患者近期心功能的影响

Efficacy of levosimendan on cardiac function of patients with decompensated heart failure

目的 评价短期静脉使用左西孟旦对失代偿性心力衰竭患者近期心功能的影响.方法 将160例心力衰竭患者应用计算机随机分为左西孟旦组和对照组各80例.对照组给予利尿剂、血管扩张剂（包括重组人脑利钠肽）、血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、螺内酯、他汀类等常规药物治疗,左西孟旦组在常规心力衰竭治疗基础上加用左西孟旦静脉维持24 h.观察治疗9d两组呼吸困难好转情况及治疗30 d心功能分级好转情况,比较两组1个月及3个月病死率情况.结果 治疗第9天左西孟旦组呼吸困难改善情况与对照组比较差异无统计学意义（P =0.126）,但左西孟旦组呼吸困难改善情况在治疗第1天（OR=2.261,95％ CI：1.280 ～3.999,P=0.005）、第3天（OR=2.002,95％CI：1.111～3.607,P=0.021）和第5天（OR=1.846,95％ CI：1.009～3.377,P=0.047）均优于对照组;校正时间因素后,治疗9d内左西孟旦组呼吸困难改善情况优于对照组（OR=1.956,95％CI：1.156 ～3.310,P=0.013）.在治疗第30天左西孟旦组心功能分级好转情况与对照组比较差异无统计学意义（P=0.115）,但左西孟旦组心功能分级好转在治疗第3天（OR=1.986,95％CI：1.195 ～ 3.300,P=0.008）、第5天（OR=2.268,95％CI：1.329～3.873,P=0.003）、第9天（OR=2.627,95％ CI：1.419～4.860,P=0.002）和第14天（OR=2.212,95％CI：1.189 ～4.112,P=0.012）均优于对照组;校正时间因素后,治疗30 d内左西孟旦组心功能分级好转情况优于对照组（OR=1.933,95％ CI：1.229～3.040,P=0.004）.左西孟旦组与对照组1个月内及3个月内的病死率差异均无统计学意义（P均＞0.05）.结论 左西孟旦能有效改善失代偿性心力衰竭患者的近期心功能.

Objective To evaluate the improvement effect of levosimendan by vein injection on short term cardiac function of patients with decompensated heart failure.Methods One hundred and sixty patients admitted due to heart failure were randomly divided into levosimendan group and control group （80 subjects for each group）.Patients in control group were given a regular therapy including diuretics,vasodilators （including the recombinant human brain natriuretic peptide）,angiotensin converting enzyme inhibitor（ACEI） or angiotensin Ⅱ receptorantagonists（ARB）,β blockers,spironolactone and stain.Patients in levosimendan were administered levosimendan for 24 hours plus regular therapy.The improvements of dyspnoea in 9 days and cardiac function classification in 30 days after therapy were assessed.Mortality of 1 month and 3 month in two group were calculated and compared during follow-up.Results The dyspnoea improvement rate was superior than that of control group during 9 days （OR =1.956,95％ CI：1.156-3.310,P =0.013）.The improvements in the levosimendan group were better than in the control group at 1 st day （OR =2.261,95 ％ CI：1.280-3.999,P =0.005）,at 3rd （OR =2.002,95 ％ CI：1.111-3.607,P =0.021） and 5th day （OR =1.846,95 ％ CI：1.009 -3.377,P =0.047）.However,there was no significant difference in term of improving dyspnoea between the levosimendan group and the control group at 9th day （P =0.126）.Similarly,the improvement of cardiac function classification in the levosimendan group was superior than the control group during 30 days （OR =1.933,95％ CI：1.229-3.040,P =0.004）.Although no significant difference was seen regarding of improving cardiac function classification between the two groups at 30th day after treatment （P =0.115）,the improvements in the levosimendan group were better than in the control group at 3rd （OR =1.986,95％ CI：1.195-3.300,P =0.008）,5th （OR =2.268,95 ％ CI：1.329-3.873,P =0.003）,9th （OR =2.627,95 ％ CI：1.419-4.860,P =0.002） and 14th day（OR =2.212,95％ CI：1.189-4.112,P =0.012）.Moreover,there was a nonsignificant reduction in terms of mortality in levosimendan group during 1-month and 3-month follow-up compared with control group （P ＞ 0.05）.Condusion Levosimendan can effectively improve the short-term cardiac function in patients with decompensated heart failure.