左西孟旦联合重组人脑钠肽治疗陈旧性心肌梗死后心力衰竭的短期疗效

Short-term efficacy of levosimendan combining recombinant human brain natriuretic peptide on heart failure after old myocardial infarction

目的观察左西孟旦联合重组人脑钠肽(rh-BNP)治疗陈旧性心肌梗死后心力衰竭的疗效及安全性。方法入选2012年12月~2014年6月解放军总医院CCU的陈旧性心肌梗死后心力衰竭患者共60例,其中男性39例,女性21例,年龄49~78岁,平均年龄(68.2±13.1)岁。所有入选者随机分为对照组和联合治疗组,每组各30例。两组均给予基础治疗,对照组加用左西孟旦,联合治疗组加用左西孟旦和rh-BNP。以脉搏指数连续心输出量(Pi CCO)监测血流动力学指标:心输出量(CO)、心脏指数(CI)、胸腔内血容积指数(ITBVI)、血管外肺水指数(EVLWI)。所有患者分别于治疗前及治疗7 d后测定左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及脑钠肽(BNP)水平,进行6分钟步行试验(6MWT)评估心功能,观察用药期间的不良反应发生率。结果两组治疗72 h后的CO、CI水平较治疗前明显提高,而ITBVI、EVLWI明显降低,差异有统计学意义(P均<0.05)。联合治疗组CO、CI、ITBVI、EVLWI明显优于对照组,分别为[(4.43±0.36)L/min vs.(3.44±0.13)L/min]、[(4.57±0.64)L/min·m^2 vs.(3.45±0.24)L/min·m^2]、[(0.72±0.08)L·m^2 vs.(0.96±0.07)L·m^2]、[(5.70±0.32)ml/kg vs.(7.39±0.76)ml/kg],差异有统计学意义(P均<0.05)。联合治疗组的每日液体出入量明显多于对照组,差异有统计学意义(P<0.05)。两组治疗7 d后的LVEF、6MWD水平较治疗前明显增加,而LVEDD、BNP水平明显降低,差异有统计学意义(P均<0.05)。与对照组治疗后比较,联合治疗组LVEF、6MWD增加,LVEDD、BNP降低,数值为[(36.71±3.24)%vs.(39.51±3.19)%]、[(236.75±58.39)m vs.(267.94±42.13)m]、[(54.3±2.4)mm vs.(51.6±3.8)mm]、BNP[(2936.81±1052.47)pg/ml vs.(2438.65±824.2)pg/ml],差异有统计学意义(P均<0.05)。两组不良反应发生率无统计学差异(P>0.05)。结论左西孟旦联合rh-BNP改善陈旧性心肌梗死后心力衰竭患者血流动力学和心功能优于单独应用左西孟旦,且安全性较好。

Objective To observe the curative effect and safety of levosimendan combining recombinant human brain natriuretic peptide（rh BNP） on heart failure after old myocardial infarction（OMI）. Methods The patients（n=60, male 39, female 21, aged from 49 to 78 and average age=68.2±13.1） were chosen from Dec. 2012 to Jun. 2014. All patients were randomly divided into control group and treatment group（each n=30）. Besides of basic therapy was given to 2 groups, control group was additionally given levosimendan and treatment group was given levosimendan and rh-BNP. The hemodynamic indexes including cardiac output（CO）, cardiac index（CI）, intrathoracic blood volume index（ITBVI） and extravascular lung water index（EVLWI） were monitored with pulse-indicated continuous cardiac output（Pi CCO）. The levels of LVEF, LVEDd and brain natriuretic peptide（BNP） were detected and heart function was reviewed by using 6-minute walk test（6MWT） before and 7 d after treatment, and incidence of adverse reactions were observed. Results The levels of CO and CI increased significantly and ITBVI and EVLWI decreased significantly in 2 groups 72 h after treatment（all P〈0.05）. In treatment group, CO [（4.43±0.36） L/min vs.（3.44±0.13） L/min], CI [（4.57±0.64） L/min·m-2 vs.（3.45±0.24） L/min·m-2], ITBVI [0.72±0.08） L·m-2 vs.（0.96±0.07） L·m-2], and EVLWI [（5.70±0.32） m L/kg vs.（7.39±0.76） m L/kg] were better significantly than those in control group（all P〈0.05）. The fluid in-put and out-put volume was significantly more in treatment group than that in control group（P〈0.05）. The levels of LVEF and 6MWD increased significantly, and LVEDD and BNP decreased significantly in 2 group 7 d after treatment（all P〈0.05）. After treatment, LVEF [（36.71±3.24）% vs.（39.51±3.19）%] and 6MWD [（236.75±58.39） m vs.（267.94±42.13） m] increased, and LVEDD [（54.3±2.4） mm vs.（51.6±3.8） mm] and BNP [（2936.81±1052.47） pg/m L vs.（2438.65±824.2） pg/m L] decreased in treatment group compared with control group（all P〈0.05）. The incidence of adverse reactions had no statistical difference between 2 groups（P〈0.05）. Conclusion Levosimendan combining rh BNP is superior to single levosimendan in improve hemodynamics and heart function in patients with heart failure after OMI with higher safety.