急诊监护室应用左西孟旦治疗老年重症顽固性心力衰竭的疗效研究

Effect of intravenous levosimendan in the treatment of 35 patients with acute intractable heart failure in the EICU

目的评价左西孟旦(Levosimendan Injection)在急诊监护室(EICU)治疗老年顽固性心力衰竭的临床研究,探讨其疗效及安全性。方法将68例重症老年顽固性心力衰竭患者随机分为治疗组和对照组。治疗组(35例)给予左西孟旦注射液治疗,对照组(33例)予以米力农治疗。比较治疗前后两组全身状况、呼吸困难程度、心功能改善程度、B型脑利钠肽(BNP)、心脏指数(CI)、左室射血分数(LVEF)和E/A等指标,定期检测血压、心率、肝肾功能及血电解质等,并记录药物相关不良反应。结果治疗72 h后,治疗组呼吸困难程度和临床状况、心功能明显改善(显效)27例,有效4例,总有效率88.6%;对照组分别为显效15例、有效6例,总有效率63.6%。两组心功能总有效率比较P<0.01。用药1周后BNP明显降低,LVEF、CI亦有明显升高(P<0.05),未发生明显药物不良反应。结论左西孟旦在EICU治疗老年重症顽固性心衰患者可迅速明显改善患者的心功能、提高射血分数等,该药疗效显著,安全可靠,值得推广应用。

Objective：To evaluate the clinical effect of levosimendan on intractable heart failure in patients in emergen-cy intensive care unit（ EICU）. Methods：Sixty-eight patients with refractory heart failure were randomly divided into treat-ment group and control group. The treatment group（35 cases）were treated with levosimendan injection therapy,the con-trol group（33 cases）with milinone injection treatment. Systemic treatment status,difficulty breathing,improvement of heart function,B type natriuretic peptide（ BNP）belly,cardiac index（ CI）,left ventricular ejection fraction（ LVEF）and E/A were compared before and after the treatment,heart rate,blood pressure,liver and kidney function and blood electro-lytes were detected regularly,and the adverse reaction of drugs was recorded. Results：After 72 hours treatment in the treatment group,degree of dyspnea and clinical status improved,heart function（ effect）in 27 cases,4 cases was effective, and the total effective rate was 88. 6%;15 cases of the control group were marked,6 cases was effective,and the total effi-ciency was 63. 6%. The total efficiency of cardiac function in the two groups was P〈0. 01. After one week,the BNP de-creased significantly,but LVEF and CI significantly increased（P〈0. 05）,and there was no obvious adverse drug reac-tion. Conclusion：Levosimendan can rapidly improve heart function of patients with intractable HF,improve the ejection fraction in EICU application,the drug effect is significant,safe and reliable,which is worthy of popularization and applica-tion.