小剂量左西孟旦与多巴酚丁胺治疗扩张型心肌病难治性心力衰竭的疗效比较

Comparison of Curative Effect of Low-dose Levosimendan and Dobutmine on Dilated Cardiomyopathy with Refractory Heart Failure

目的探讨左西孟旦注射液治疗扩张型心肌病难治性心力衰竭的疗效与安全性。方法将72例扩张型心肌病难治性心力衰竭患者随机分为两组,两组给予常规药物治疗(如利尿剂、地高辛等),观察组(n=36)用左西孟旦注射液12.5mg加5%葡萄糖注射液45ml以0.1μg/(kg·min)持续静脉泵注约35h(直至药物用完)。对照组(n=36)用多巴酚丁胺注射液以3μg/(kg·min)持续静脉泵注约35h。观察治疗后的纽约心功能、左室射血分数(LVEF)、每搏输出量(SV)、左室舒张末内径(LVEDD)、脑钠肽(BNP)变化及不良反应。结果观察组心功能改善总有效率明显高于对照组(83.33%比58.33%,P<0.05),观察组治疗前后LVEF[(30.11±7.65)%比(36.72±8.43)%]、SV[(51.46±20.75)ml比(69.81±20.13)ml]、BNP[(2377.56±735.72)pg/ml比(1644.38±623.61)pg/ml]明显改善,差异有统计学意义(P<0.05)。对照组治疗前后LVEF[(29.12±6.71)%比(32.67±7.53)%]、SV[(50.39±19.62)ml比(59.98±21.05)ml]、BNP[(2527.06±865.32)pg/ml比(1964.73±647.51)pg/ml]也明显改善,差异有统计学意义(P<0.05)。两组治疗后LVEF[(36.72±8.43)%比(32.67±7.53)%]、SV[(69.81±20.13)ml比(59.98±21.05)ml]和BNP[(1644.38±623.61)pg/ml比(1964.73±647.51)pg/ml]比较差异也有统计学意义(P<0.05)。两组在治疗前后LVEDD比较差异均无统计学意义(P>0.05)。两组不良反应率比较差异无统计学意义(30.55%比25.00%,P>0.05)。结论小剂量左西孟旦注射液治疗扩张型心肌病难治性心力衰竭疗效显著,优于多巴酚丁胺,不良反应少。

Objective To explore efficacy of low-dose levosimendan in the treatment of dilated cardiomyopathy with refractory heart failure. Methods 72 patients of dilated cardiomyopathy with refractory heart failure were randomly divided into the observation group（ n = 36） and the control group（ n = 36）. Two groups were given conventional therapy,such as diuretic and digoxin and so on. The observation group patients were administered continuously intravenous injection of low dose levosimendan by0. 1μg /（ kg· min） about 35 hours. The control group patients were given continuously intravenous injection of routine dose dobutamine by 3μg /（ kg·min） about 35 hours. After the therapy,the following items were observed and compared between the two groups： NYHA classification,left ventricular ejection fraction（ LVEF）,stroke volume（ SV）,left ventricular end-diastolic diameter（ LVEDD）,B-type natriuretic peptide（ BNP） and side effects. Results Compared with the control group,there was a significant increase in total effective rate of cardiac function improvement（ 83. 33% VS. 58. 33%,P〈0. 05）. Compared with the observation group before therapy,there were statistical significant improvements after therapy in LVEF[（ 30. 11 ± 7. 65） %VS.（ 36. 72 ± 8. 43） %] and SV[（ 51. 46 ± 20. 75） ml VS.（ 69. 81 ± 20. 13） ml] and BNP [（ 2377. 56 ± 735. 72） pg / ml VS.（ 1644. 38 ±623. 61） pg/ml]（ P〈0. 05）. Compared with the control group before therapy,statistical significant improvements were also observed in LVEF[（ 29. 12 ± 6. 71） % VS.（ 32. 67 ± 7. 53） %]and SV[（ 50. 39 ± 19. 62） ml VS.（ 59. 98 ± 21. 05）ml] and BNP[（ 2527. 06 ± 865. 32） pg / ml VS.（ 1964. 73 ± 647. 51） pg / ml]（ P〈0. 05）. Compared with the control group after therapy,statistical significant improvements were observed in the observation group in LVEF[（ 36. 72 ± 8. 43） % VS.（ 32. 67 ±7. 53） %] and SV[（ 69. 81 ± 20. 13） ml VS.（ 59. 98 ± 21. 05） ml] and BNP [（ 1644. 38 ± 623. 61） pg / ml VS.（ 1964. 73 ±647. 51） pg / ml]（ P〈0. 05）. Compared with which before therapy respectively,there is no statistical significant difference of LVEDD between two groups [（ 62. 38 ± 9. 73） mm VS.（ 61. 57 ± 10. 63） mm]（ P〉0. 05）. Compared with the two groups which after therapy in the two groups,there was no change in LVEDD[（ 61. 57 ± 10. 63） mm vs.（ 62. 47 ± 9. 83） mm]（ P〉0. 05）.Also,there was no change in side effects（ 30. 55% VS. 25. 00%,P〉0. 05）. Conclusions Low-dose Levosimendan has a better effect on dilated cardiomyopathy with refractory heart failure than dobutamine. The side effects were also less than the dobutamine.