左西孟旦联合重组人脑利钠肽治疗急性心力衰竭的临床研究

Clinical effect of levosimendan combined with recombinant human brain natriuretic peptide on acute decompensated heart failure

目的:观察左西孟旦联合国产重组人脑利钠肽(rh-BNP)治疗急性失代偿性心力衰竭(ADHF)的疗效及安全性。方法:选择心功能Ⅳ级或KillipⅢ级ADHF住院患者,用SAS软件随机分为传统治疗的对照组和应用左西孟旦+rh-BNP的试验组各30例,观察治疗前后临床参数变化和不良事件。结果:试验组呼吸频率(RR)、心率(HR)、收缩压(SBP)、血氧饱和度(SaO2)、平均肺毛细血管楔压(MPCWP)、心排血量(CO)在治疗后2h及其后各时间点与治疗前比较均差异有统计学意义(均P<0.05)。对照组治疗4h及其后各时间点与治疗前比较各指标均差异有统计学意义(均P<0.05)。试验组上述指标较对照组在治疗后2、4h均差异有统计学意义(均P<0.05),且RR、HR、MPCWP、CO的组间差异持续至用药后24h;试验组治疗后尿量、72h利尿剂总量、血浆BNP浓度、左室射血分数(LVEF)及CCU住院时间均显著好于对照组(P<0.05)。不良事件:用药前后两组肝功能、电解质、凝血等指标未发现有临床意义的变化。结论:左西孟旦联用rh-BNP治疗ADHF患者较传统治疗更快更显著改善患者血流动力学,增加尿量,降低BNP浓度,改善临床症状,提高LVEF,减少住院时间,耐受性和安全性良好。

Objeetive To observe the efficacy and safety of levosimendan combined with recombinant human brain natriuretic peptide （rh-BNP） in treating patients with acute decompensated heart failure （ADHF）. Methods.. Hospitalized patients with ADHF （NYHA Functional Class IV or Killip ]]] ） were divided into two groups （n= 30, respectively） ： control group （receiving dobutamine and/or cedilanid on the basis of essential therapy） and experi- mental group （receiving levosimendan combined with rh-BNP on the basis of essential therapy） according to the SAS software-generated randomization schedule. The hemodynamics, clinical parameters of test and adverse events were observed before and after treatment. Results：In experimental group, compared with those before treat- ment, there were statistical differences in respiratory rate （RR）, heart rate （HR）, systolic blood pressure （SBP）, arterial blood gas oxygen saturation （SaO2）, mean pulmonary capillary wedge pressure （MPCWP）, cardiac output （CO） at 2 h and the following time points after treatment （all P〈0.05）. In control group, there were statistical differences in RR, HR, SaO2, MPCWP, CO at 4 h after treatment and in the next time points （all P〈0.05）. RR, HR, SBP, SaO2, MPCWP, CO at 2 and 4 h after treatment had statistical differences, and the differences in RR, HR, MPCWP, CO persisted for 24 hours after medicine administration. There was a statistically significant difference between two groups in urine volume, total dosage of diuretics, left ventricular ejection fraction （LVEF）, plasma BNP and length of stay in CCU （all P（0. 05）. For adverse events monitoring, there was no significant change between two groups in hepatic parameters, electrolyte level and coagulation function before and after treatment. Conclusion： Levosimendon combined with rh-BNP is superior to the conventional drugs in improving hemodynamics, increasing urine volume, decrea- sing the BNP concentration, improving clinical symptoms, increasing LVEF, and reducing the length of stay in CCU in patients with ADHF, which has better toleranee and safety.