左西孟旦联合多巴酚丁胺对难治性心力衰竭患者的疗效

Therapeutic effect of levosimendan combined dobutamine on refractory heart failure

目的:探讨左西孟旦联合多巴酚丁胺治疗难治性心力衰竭(RHF)患者的临床疗效。方法:选择2014年4月至2015年10月我院收治的90例RHF患者,根据随机数字表法,患者被随机均分为多巴酚丁胺组和联合治疗组(接受多巴酚丁胺联合左西孟旦治疗)。比较两组治疗后心功能改善情况,以及治疗期间的不良反应。结果:联合治疗组治疗后的心功能改善率显著高于多巴酚丁胺组(86.7%比60.0%),P=0.02。与治疗前比较,两组治疗后呼吸困难评分均显著降低,LVEF和SV均显著升高(P<0.05或<0.01);与多巴酚丁胺组比较,联合治疗组治疗后呼吸困难评分[(1.58±0.78)分比(1.02±0.47)分]降低更显著,LVEF[(42.61±7.10)%比(50.21±7.82)%]和SV[(57.62±14.63)ml比(64.21±15.12)ml]升高更显著,P<0.05或<0.01。两组患者均发生低血压、心肌缺血、心律失常等不良反应,总不良反应发生率无显著差异(P>0.05)。结论:应用左西孟旦联合多巴酚丁胺治疗难治性心力衰竭患者疗效显著,且安全性好,值得推广。

Objective： To explore therapeutic effect of levosimendan combined dobutamine on refractory heart failure （RHF）. Methods： A total of 90 RHF patients, who were treated in our hospital from Apr 2014 to Oct 2015, were selected. According to random number table, patients were randomly and equally divided into dobutamine group and combined treatment group （received dobutamine combined levosimendan）. Cardiac function improvement after treatment, and adverse reactions during treatment were compared between two groups. Results： After treatment, cardiac function improvement rate of combined treatment group was significantly higher than that of dobutamine group （86. 7% vs. 60. 0%）, P = 0.02. Compared with before treatment, after treatment, there was significant reduction in dyspnea score, and significant rise in LVEF and stroke votume （SV） in both groups （P〈0. 05 or 0.01） ; compared with dobutamine group after treatment, there was significant reduction in dyspnea score [ （1.58 ± 0.78） scores vs. （1.02 ± 0.47） scores], and significant rise in LVEF [ （42.61 ± 7. 10） % vs. （50.21 ± 7. 82） %] and SV [ （57. 62 5： 14. 63） ml vs. （64. 21 ± 15.12） ml] in combined treatment group, P-〈0.05 or 〈0.01. Hypotension, myocardial ischemia and arrhythmia etc. occurred in both groups, but there was no significant difference in inci- dence rate of total adverse reactions （P〉0. 05）. Conelusion： Levosimendan combined dobutamine possess significant therapeutic effect on refractory heart failure and safety is good, which is worth extending.