左西孟旦治疗顽固性心力衰竭合并肾功能不全的对照研究

A control study on levosimendan in treatment of refractory heart failure complicating severe renal insufficiency

目的研究左西孟旦治疗顽固性心力衰竭合并肾功能不全的疗效。方法将重庆市中山医院心内科67例顽固性心力衰竭合并重度肾功能不全患者分为左西孟旦治疗组(L组,n=33),多巴胺治疗组(D组,n=34)。比较、分析治疗后1、3、7、30d患者N-末端脑钠肽前体(NT-pro-BNP)、左心室射血分数(LVEF)、肾小球滤过率(GFR)的变化。结果治疗前,两组间基线指标差异无统计学意义(P>0.05)。L组:NT-pro-BNP治疗后1、3、7d较基线显著下降(P<0.05),LVEF治疗后3、7d较基线显著上升(P<0.05),GFR治疗后1、3、7、30d与基线比较显著上升(P<0.05)。D组:NT-pro-BNP治疗后7d较基线显著下降(P<0.05),LVEF治疗后7d较基线显著上升(P<0.05),GFR治疗后1、3、7、30d较基线差异无统计学意义(P>0.05)。治疗后,NT-pro-BNP、LVEF、GFR的显著水平值L组均优于D组。结论左西孟旦改善顽固性心力衰竭合并重度肾功能不全患者心、肾功能水平优于多巴胺。

Objective To study the efficacy of levosimendan in treating refractory heart failure complicating severe renal insufficiency.Methods Sixty-seven cases of refractory heart failure complicating severe renal insufficiency in the internal medicine department of our hospital were randomly divided into the levosimendan treatment group（L group,n=33）and dopamine treatment group（D group,n=34）.The changes of N-terminal pro-B-type natriuretic peptide（NT-pro-BNP）,left ventricular ejection fraction（LVEF）and glomerular filtration rate（GFR）before treatment and on 1,3,7,30 dafter treatment were compared between the two groups and analyzed.Results Before the treatment,there were no statistically significant differences in the baseline indicators between the two groups（P〈0.05）.The group L：the NT-pro-BNP level on 1,3,7dafter treatment was decreased significantly（P〈0.05）,LVEF on 3,7dwas significantly increased compared with th baseline（P〈0.05）and GFR on 1,3,7,30 dwas significantly increased compared with the baseline（P〉0.05）.The group D：the NT-pro-BNP level on 7dof treatment was significantly decreased（P〈0.05）,LVEF on 7dof treatment was significantly increased compared with the baseline（P〈0.05）,and no statistically significant changes were observed in GFR on 1,3,7,30d（P〉0.05）.After treatment,NT-pro-BNP,LVEF and GFR significant level values in the group L were better than those in the group D.Conclusion Levosimendan is superior to dopamine in improving heart and renal function for the patients with refractory heart failure complicating severe renal insufficiency.