左西孟旦治疗急性心肌梗死后心力衰竭疗效分析

Effect of levosiinendan in the treatment of heart failure in patients with acute myocardial infarction

目的评价左西孟旦对急性sT段抬高型心肌梗死（STEMI）直接经皮冠状动脉介入治疗（PCI）后并发心力衰竭（HF）的疗效和安全性。方法选取STEMI经直接PCI后出现HF的患者95例，采用随机数字表法分为常规治疗组和左西孟旦组，检测两组治疗前以及治疗24h、1周后血清脑钠肽前体（NT．proBNP）、左室舒张末期容积（LVSD）和左室射血分数（LVEF），同时依据症状、体征、LVEF变化，比较两组临床疗效及不良反应发生率。结果常规治疗组治疗前NT-proBNP、LVEF、LVSD分别为（5908．1±33．2）ng／L、（36．7±4．3）％、（6．1±0．6）cm，治疗24h后分别为（3478．5±19．3）ng／L,、（45．0±6．3）％、（5．9±0．3）cm，治疗1周后分别为（3375．2±32．1）ng／L、（48．3±5．4）％、（5．8±1．1）cm，治疗24h后较治疗前血清NT—proBNP降低、LVEF升高（t=3．86、4．11，P=0．021、0．015），治疗1周后较治疗前、治疗24h后血清NT—proBNP降低、LVEF升高（较治疗前比较：t=4．13、5．06，P=0．016、0．013；较治疗24h后比较：t=3．96、4．77，P=0．021、0．015），LVSD差异无统计学意义（P〉0．05）。左西孟旦组治疗前NT—proBNP、LVEF、LVSD分别为（6022．6±42．2）ng／L、（33．1±5．1）％、（6．0±0．3）cm，治疗24h后分别为（3340．5±19．2）ng／L、（43．3±3．9）％、（5．3±0．7）cm，治疗1周后分别为（2938．3±12．8）ng／L、（52．7±8．2）％、（4．6±0．2）cm，治疗24h后较治疗前血清NT-proBNP降低、LVEF升高、LVSD降低（t=6．07、6．49、5．73，P=0．010、0．008、0．011），治疗1周后较治疗前、治疗24h后血清NT-proBNP降低、LVEF升高、LVSD降低（与治疗前比较：t=6．55、7．05、5．33，P=0．008、0．007、0．012；与治疗24后比较：t=5．19、6．89、4．97，P=0．015、0．078、0．014）。两组治疗24h后NT—proBNP、LVEF差异均无统计学意义（均P〉0．05），LVSD差异有统计学意义（t=4．84，P=0．015）；两组治疗1周后，NT-proBNP、LVEF、LVSD差异均有统计学意义（t=6．60、7．01、5．40，P=0．007、0．007、0．011）。治疗24h后两组有效率、获益率差异均无统计学意义（均P〉0．05）；治疗1周后，左西孟旦组有效率、获益率分别为66．6％、95．6％，均高于常规治疗组的59．6％、89．5％（Х^2=9．72、15．63，P=0．015、0．008）。两组不良反应发生率差异无统计学意义（P〉0．05）。结论左西孟旦对STEMI直接PCI治疗后并发HF具有良好的疗效和安全性。

Objective To evaluate the efficacy and safety of levosimendan applied in patients with chronic heart failure combined with acute ST - elevation myocardium after direct percutaneous coronary intervention （PCI）. Methods Using the random number table method,95 patients with heart failure combined with acute ST - elevation myoeardium after direct PCI were randomly divided into two groups ： the general treatment group and the levosimendan group. The levels of serum NT - proBNP, LVSD, LVEF before and after 24h, one week treatment were examined. After the experiment,clinical assessment was performed to evaluate the efficacy and safety of levosimendan. Results The results of NT - proBNP, LVEF and LVSD in the general group before treatment were （ 5 908. 1 ± 33.2） ng/L, （36.7 ±4.3）% and （6.1 ±0.6）cm,while those were （3 478.5 ± 19.3）ng/L,（45.0 ±6.3）% ,（5.9 ±0.3）cm, （ 3 375.2 ± 32.1 ） ng/L, （48.3 ± 5.4 ） % and （ 5.8 ± 1.1 ） cm after 24h and 1 week treatment. The level of serum NT -proBNP decreased,while the LVEF increased in general treatment group after 24h treatment （t = 3.86,4.11, P =0. 021,0. 015 ）. The same results happened after I week treatment （compared with before treatment, t = 4.13,5.06, P = 0.016,0.013, compared with 24 hours after treatment, t = 3.96,4.77, P = 0. 021,0.015 ）. But the level of the LVSD had no differences before and after 24h,1 week treatment（P 〉0.05）. The results of NT -proBNP,LVEF and LVSD in the levosimendan group before treatment were （3 340.5 ± 19.2 ） ng/L, （43.3 ± 3.9 ） %, （ 5.3 ± 0.7 ） cm, （2 938.3 ± 12.8） ng/L, （52.7 ± 8.2） % and （4.6 ± 0.2） cm after 2gh and 1 week treatment. The levels of serum NT - proBNP, LVSD decreased, while the LVEF increased in the levosimendan group after 2gh, 1 week treatment（ t = 6.07,6.49,5.73,P =0.010,0. 008,0. 011. t = 6.55,7.05,5.33,P =0. 009,0. 007,0. 012）. Compared with the general treatment group,the levels of serum NT- proBNP, LVEF showed no differences （all P 〉 0.05 ）, but the level of the LVSD decreased after 24h treatment （ t = 4.84, P = 0. 015 ） in the levosimendan group. The levels of serum NT - proBNP, LVSD decreased, while the LVEF increased in the levosimendan group after 1 week treatment compared with the general treatment group （ t = 6.60,7.01,5. 40, P = 0. 007,0. 007,0.011 ）. After one week treatment, the effective and beneficial rates of the levosimendan group were 66.6% and 95.6%, while those were 59.6% and 89. 5% in the general treatment group. The therapeutic effects of levosimendan group were more effective than the general treatment group after 1 week treatment （Х^2 = 9.72,15.63, P = 0. 015,0. 008）, but had no statistical differences between the two groups after 24h treatment （ P 〉 0.05 ）. There was no statistical differences between the two groups in the rate of adverse reactions. Conclusion Levosimendan has very favorable efficacy and safety for patients with chronic heart failure combined with acute ST - elevation myocardium infarction after direct PCI.