左西孟旦治疗60例重度心力衰竭患者疗效观察

Effect of levosimendan in treating severe heart failure: an observation report on 60 cases

目的研究静脉注射左西孟旦治疗心力衰竭患者的疗效。方法选取我科2012年1月至2014年1月收治的心力衰竭患者60例,其中缺血性心肌病30例,扩张型心肌病30例。常规药物治疗效果不佳,加用左西孟旦注射液治疗,使用方法按说明书:治疗的初始负荷剂量为12μg/kg,注射时间10 min,之后持续输注0.1μg·kg-1·min-1。应用左西孟旦治疗48 h后,比较左心室射血分数(left ventricular ejection fraction,LVEF)、每搏心输出量(stroke volume,SV)和N末端脑钠肽(N-terminal brain natriuretic peptide,NT-BNP)较治疗前的改善情况,以综合评价左西孟旦治疗心力衰竭的疗效。结果治疗48 h后,LVEF上升均值6.41%,与用药前比较差异有统计学意义(P<0.05);其中缺血性心肌病组(8.32%)比扩张型心肌病组(4.5%)升高,两组比较差异有统计学意义(P<0.05)。SV上升均值为13.91 mL,与用药前比较差异有统计学意义(P<0.05);缺血性心肌病组SV上升均值(17.56 mL)比扩张型心肌病组(10.26 mL)高,两组比较差异有统计学意义(P<0.05)。NT-BNP下降均值为4 051 pg/mL,与用药前比较差异有统计学意义(P<0.05);用药后患者呼吸困难和全身临床状况显著改善。结论与常规治疗比较,左西孟旦注射液治疗重度失代偿性心力衰竭疗效确切;左西孟旦注射液对缺血性心肌病患者血流动力学的改善优于扩张型心肌病。

Objective To study the clinical effect on heart failure patients with intravenous use of levosimendan.Methods We collected 60 cases of heart failure patients from January 2012 to January 2014,including 30 cases with ischemic cardiomyopathy and 30 with dilated cardiomyopa-thy.Since conventional drugs did not work,these patients were given intravenous injection of levosi-mendan.According to the instructions,the initial loading dose was 12 μg/kg in 10 minutes,and then continuous dose remained to be 0.1 μg·kg^-1 ·min^-1 .For heart failure patients,the clinical efficacy of levosimendan was evaluated by comparing the improvements of some indexes 48 hours af-ter the drug therapy and before.The indexes included left ventricular ejection fraction （LVEF）, stroke volume（SV）,and N-terminal brain natriuretic peptide（NT-BNP）.Results The mean value of LVEF increased by 6.41%48 hours after the treatment than before,and the difference was statis-tically significant（P〈0.05）.The increase of LVEF in ischemic cardiomyopathy group（increase by 8.32%）was significantly higher than that in dilated cardiomyopathy group（increase by 4.5%）,and the difference was statistically significant（P〈0.05）.The average increase of SV was 13.91 mL after the treatment,and the difference was statistically significant if （P〈0.05）if compared with SV value before the processing. The average increase of SV in ischemic cardiomyopathy group （17.56 mL）was significantly higher than that in dilated cardiomyopathy group（10.26 mL）,and the difference was statistically significant（P〈0.05）.The average decrease of NT-BNP was 4 051 pg/mL after the treatment,and the difference was statistically significant if （P〈0.05 ）if compared with the value before the processing.With the use of levosimendan,dyspnea was relieved and the overall physical status of heart failure patients was improved significantly.Conclusion Compared with rou-tine treatment,intravenous use of levosimendan proves to be effective in patients with severe decom-pensated heart failure.It ameliorates hemodynamics indexes of ischemic cardiomyopathy patients better than those of dilated cardiomyopathy cases.