左西孟旦与米力农治疗难治性心力衰竭的临床疗效比较

Comparison in clinical efficacy between levosimendan and milrinone in treatment of refractory heart failure

目的对比左西孟旦与米力农治疗难治性心力衰竭(心衰)的临床疗效。方法纳入2014年12月~2016年12月期间于南通市通州区人民医院心内科治疗的难治性心衰患者66例,其中男性32例,女性34例,年龄44~89岁,平均年龄(61.10±16.08)岁。采用随机数字表法分为观察组(34例)和对照组(32例)。两组患者在常规抗心衰治疗的基础上,对照组加用米力农注射液;观察组加用左西孟旦注射液。两组患者均连续治疗1周。检测两组治疗前后血清N末端脑钠肽前体(NT-pro BNP)水平,超声心动图检测左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)。治疗前后评估美国纽约心脏协会(NYHA)心功能分级,治疗后评价临床疗效,记录治疗期间不良反应情况。结果经过药物治疗后,观察组总有效率显著高于对照组(79.41%vs.53.13%),差异具有统计学意义(P<0.05)。治疗后对照组NYHA心功能Ⅱ级1例(3.13%),Ⅲ级14例(43.75%),Ⅳ级16例(50.00%);观察组Ⅱ级3例(8.82%),Ⅲ级23例(67.65%),Ⅳ级8例(23.53%)。与对照组治疗后比较,观察组NYHA心功能分级改善更明显。治疗后,两组患者NT-pro BNP及LVEF、LVEDD、LVESD较治疗前均明显改善,观察组改善更明显,差异有统计学意义(P均<0.05)。观察组与对照组不良反应发生率比较,差异无统计学意义(P>0.05)。结论难治性心力衰竭患者采用常规抗心力衰竭联合左西孟旦治疗,有效改善心功能、左室重构和临床疗效,显著优于联用米力农。

Objective To compare the clinical efficacy between levosimendan and milrinone in treatment of refractory heart failure（RHF）. Methods RHF patients（n=66, male 32, female 34, aged from 44 to 89 and average age=61.10±16.08） were chosen from the Department of Cardiology of the People＇s Hospital of Tongzhou District of Nantong City from Dec. 2014 to Dec. 2016. All patients were divided, according to random digital table, into observation group（n=34） and control group（n=32）. Based on the routine therapy of anti-RHF, control group was given milrinone injection and observation group was given levosimendan injection for one week. The levels of serum N-terminal pro-brain natriuretic peptide（NT-pro BNP） was detected, and indexes of left ventricular ejection fraction（LVEF）, left ventricular end-diastolic inner diameter（LVEDD） and left ventricular end-systolic diameter（LVESD） were detected by using echocardiogram in 2 groups before and after treatment. The grading of New York Heart Function Assessment（NYHA） was reviewed before and after treatment, clinical efficacy was reviewed after treatment, and adverse reactions were recorded during treatment period. Results The total effective rate was significantly higher in observation group than that in control group（79.41% vs. 53.13%, P〈0.05） after treatment. In control group, there was 1 patients（3.13%） with NYHA grade Ⅱ, 14（43.75%） with NYHA grade Ⅲ and 16（50.00%） with NYHA grade Ⅳ after treatment. In observation group, there were 3 patients（8.82%） with NYHA grade Ⅱ, 23（67.65%） with NYHA grade Ⅲ and 8（23.53%） with NYHA grade Ⅳ after treatment. The improvement of NYHA grading was more significant in observation group than that in control group after treatment. The indexes of NTpro BNP, LVEF, LVEDD and LVESD were all improved in 2 groups after treatment, which was more significant in observation group（all P〈0.05）. The comparison in incidence of adverse reactions between 2 groups showed that the difference had no statistical significance（P〈0.05）. Conclusion The routine anti-RHF therapy combining levosimendan can effectively improve heart function, left ventricular remodeling and clinical efficacy in RHF patients, which is significantly superior to routine anti-RHF therapy combining milrinone.