左西孟旦联合单硝酸异山梨酯治疗顽固性心力衰竭的临床研究

Clinical study on levosimendan combined with isosorbide mononitrate in treatment of refractory heart failure

目的探讨左西孟旦联合单硝酸异山梨酯治疗顽固性心力衰竭的临床疗效。方法选取2014年1月—2016年10月在河南省中医院接受治疗的顽固性心力衰竭患者78例,根据治疗方案的不同分为对照组(39例)和治疗组(39例)。对照组静脉泵入单硝酸异山梨酯注射液,20 mg加入5%葡萄糖溶液50 m L中,1次/d。治疗组在对照组的基础上静脉泵入左西孟旦注射液,初始负荷剂量为12μg/kg,持续时间>10 min,然后以0.1μg/(kg·min)维持。两组患者均治疗14 d。比较两组患者治疗前后临床疗效、心功能指标和血清细胞因子水平。结果治疗后,对照组总有效率为64.10%,显著低于治疗组的87.18%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者左心室射血分数(LVEF)和心脏指数(CI)显著升高,左室舒张末期内径(LVEDD)明显降低,同组比较差异具有统计学意义(P<0.05);且治疗组心功能指标明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者血清N-末端B型利钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平均低于治疗前,同组比较差异具有统计学意义(P<0.05);且治疗组患者细胞因子水平比对照组降低的更显著,两组比较差异具有统计学意义(P<0.05)。结论左西孟旦联合单硝酸异山梨酯治疗顽固性心力衰竭的临床效果明显,可明显改善患者心功能和机体细胞因子水平,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of levosimendan combined with isosorbide mononitrate in treatment of refractory heart failure. Methods Patients （78 cases） with refractory heart failure in Henan Province Hospital of TCM from January 2014 to October 2016 were divided into control （39 cases） and treatment （39 cases） groups based on different treatments. Patients in the control group were intravenous pumping administered with Isosorbide Mononitrate Injection, 20 mg added into 5% glucose solution 50 mL, once daily. Patients in the treatment group were intravenous pumping administered with Levosimendan Injection on the basis of the control group, the initial load dose was 12 μg/kg, and the time of which was more than 10 min, then maintained the treatment with 0.1μg/（kg·min）. Patients in two groups were treated for 14 d. After treatment, clinical efficacy, cardiac function index, and serum cytokines in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 64.10%, which were significantly lower than 87.18% in the treatment group, and there were differences between two groups （P 〈0.05）. After treatment, the LVEF and CI in two groups were significantly increased, but LVEDD was significantly decreased, and there were differences in the same group （P 〈 0.05）. And the cardiac function indexes in treatment group were significantly better than those in the control group, with significant difference between two groups （P 〈 0.05）. After treatment, the serum hs-CRP, IL-6, TNF-α, and NT-proBNP levels in two groups were significantly decreased, and the difference was statistically significant in the same group （P 〈 0.05）. And these serum cytokines levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups （P 〈 0.05）. Conclusion Levosimendan combined with isosorbide mononitrate has obvious clinical effect in treatment of refractory heart failure, and can significantly improve the cardiac function and cytokines levels, which has a certain clinical application value.