左西孟旦治疗急性失代偿性心力衰竭并发急性肾损伤患者临床观察

Clinical study on levosimendan for treating acute decompensated heart failure patients with acute kidney injury

目的观察左西孟旦治疗急性失代偿性心力衰竭(ADHF)并发急性肾损伤(AKI)患者的临床疗效和安全性。方法选取60例ADHF并发AKI患者,随机分为对照组(多巴酚丁胺组)和观察组(左西孟旦组)各30例,比较两组患者治疗前后血浆B型脑利钠肽(BNP)水平及左室射血分数(LVEF)和左室舒张末期内径(LVEDD)评价左心功能,以及比较两组患者治疗前后血肌酐(Cr)、血浆胱抑素C(CysC)水平和计算肾小球滤过率(GFR)评价肾脏功能改善情况,同时观察两组患者药物不良反应发生情况。结果治疗后两组患者血浆BNP水平较治疗前明显下降,LVEF较治疗前升高,且观察组改善程度优于对照组;两组患者血Cr和CysC水平治疗后较治疗前明显下降,且观察组CysC水平下降更显著;GFR治疗后较治疗前升高,观察组较对照组升高更显著。以上比较差异均有统计学意义(P<0.05)。结论左西孟旦能够显著改善ADHF患者左心功能,提高左室排血量,有效治疗因ADHF而引起的急性肾功能损伤。

Objective To investigate the efficacy and safety of lcvosimendan in the patients with acute decompensated heart failure（ADHF） combined with acute kidney injury（AKI）. Methods 60 patients with ADHF combined with AKI were enrolled in this study and randomly divided into control group（dopamine group）and observation group（levosimendan group）, 30 cases in each group. The left ventricular ejection fraction （LVEF） ,left ventricular end-diastolic dimension（LVEDD）and plasma B-type natriuretic peptide（BNP）for evaluating cardiac function before and after the treatment in two groups were compared; at the same time, the serum creatine（Cr）, Cystatin C（CysC）level and estimated glomerular filtration rate（GFR）for evaluating the＇renal function before and after the treatment in two groups were compared. In addition, the adverse drug reactions were observed in two groups during the process of treatment. Results After treatment,the BNP were significantly decreased and the LVEF significantly improved than that before treatment in two group,the improvement in the observation group was more significantly than that in the control group; the level of serum Cr and CysC after treatment were significantly decreased than before treatment, and the CysC of the observation group decreased more significantly;the GFR levels after treatment were increased than that before treatment,and in the observation group increased more obviously than that in the control group. All those differences were statistical significance（P 〈 0. 05）. Conclusions Levosimendan can effectively improve the cardiac output and cardiac function,and treat acute kidney injury caused by ADHF.