左西孟旦注射液单次与多次注射给药治疗晚期心力衰竭急性加重患者临床观察

Clinical Observation of Levosimendan Injection at Single Dose and Multiple Doses in Patients with Acute Exacerbation of Advanced Heart Failure

目的:比较左西孟旦单次与多次注射给药对晚期心力衰竭急性加重患者左心功能、生物标记物及神经激素活性的影响。方法:39例晚期心力衰竭急性加重患者随机分为单次给予左西孟旦和多次给予左西孟旦治疗2组,所有患者基线时均先静脉给予左西孟旦6μg·kg^(-1)的负荷剂量,继而以0.1μg·kg^(-1)·min^(-1)持续24h静脉泵入,多次给药组在治疗1个月及6个月时分别再以上述方法给药1次。比较两组患者治疗前、治疗3d及治疗6个月时的左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室射血分数(LVEF)、二尖瓣环收缩速度(Sm)、心肌做功指数(MOI)、血脑钠肽(NT-pro BNP)、肿瘤坏死因子-α(TNF-α)及白介素-6(IL-6)。结果:治疗3d时两组患者的LVESF、LVEF、Sm、MPI、NT-pro BNP、IL-6及TNF-α均较治疗前显著改善(P<0.05);治疗6个月时多次给药组的LVESF、LVEDF、LVEF、Sm、MPI、NT-pro BNP、IL-6及TNF-α等指标分别较本组治疗前和单次给药组同期显著改善(P<0.05)。结论:多次静脉给予左西孟旦在改善血流动力学及炎性因子方面等方面优于单次注射给药。

Objective： To compare the effects of levosimendan injection at single dose and multiple doses on the left ventricular function, biomarkers and neuroho-rmonal activity in the patients with acute exacerbation of advanced heart failure. Methods： Totally 39 patients with chronic heart failure at acute exacerbation were divided into two groups, single dose group and multiple doses group. All the patients were given loading dose of 61μg·kg-1 levosimendan at baseline, and then given 0.1 μg·kg-1 · min- l continuous 24h in- fusion pump. The above regimen was administered once again after one month and six months in the patients of multiple doses group. Left ventricular end systolic volume （ LVESV）, left ventricular end diastolic volume （ LVEDV）, left ventricular ejection fraction （LVEF）, mitral annulus systolic velocity （SM）, myocardial performance index （MOI）, blood brain natriuretic peptide （NT-proB- NP）, tumor necrosis factor alpha （TNF-ct） and interleukin 6 （IL-6） were compared between the two groups before the treatment, and after tge three-day and 6-month treatment. Results： Compared with those before the treatment, LVESF, LVEF, Sm, MPI, NT-proB- NP, IL-6 and TNF-odn in the two groups were significantly improved after the three-day treatment （P 〈 0.05）. The indices were sig- nificantly improved in multiple doses group after the 6-month treatment when compared with those before the treatment and in single dose group, and the differences were statistically significant （P 〈 0.05）. Conclusion： Repeated intravenous administration of levosi- mendan is superior to the single dose administration in improving hemodynamics and inflammatory factors.