左西孟旦治疗心肌梗死伴无症状左室收缩功能异常患者的临床观察

Treatment of myocardial infarction complicated by asymptomatic left ventricular systolic dysfunction with levosimendan

目的探讨左西孟旦治疗心肌梗死伴无症状左室收缩功能异常患者的临床疗效和安全性。方法收集平顶山市第一人民医院心内科于2015年2月~2017年1月间的148例采用保守治疗的急性心肌梗死(AMI)患者,随机分为对照组(n=74)和治疗组(n=74),对照组患者在给予拜阿司匹林(口服,300 mg/d)、普伐他汀(口服,20 mg/d)、氯吡格雷(口服,300 mg/d)等药物进行抗血小板聚集、抗凝及抗缺血药物和溶栓等常规治疗基础上采用β受体阻滞剂,口服50~100 mg,2/d。治疗组患者在对照组治疗基础上,另外静脉注射左西孟旦注射液,左西孟旦首先给予12μg/kg负荷剂量,泵入≥10 min;然后持续静脉泵入0.05~0.2μg/(kg·min),给药24 h。观察患者用药前、用药后7 d心率(HR)、收缩压(SBP)、舒张压(DBP);用药前和用药7 d后NYHA心功能分级、N末端脑钠肽前体(NT-pro BNP)水平、胰岛素样生长因子1(IGF-1)水平变化及心脏超声参数,包括左室射血分数(LVEF)、左室舒张末容积(LVEDV)、左室收缩末容积(LVESV)、每博量(SV)。结果用药后7 d,两组患者HR比较,差异具有统计学意义(P<0.05),但两组SBP和DBP比较,差异无统计学意义(P>0.05)。用药后7 d,两组患者LVEF、SV、LVEDV和LVESV比较,差异具有统计学意义(P<0.05),治疗组LVEF和SV均较对照组高,治疗组LVEDV和LVESV较对照组低。用药后7 d,两组患者血清NT-pro BNP和IGF-1水平比较,差异具有统计学意义(P<0.05)。用药后7 d,两组患者NYHA心功能分级情况比较,差异具有统计学意义(P<0.05)。另外,两组患者不良反应发生情况差异无统计学意义(P>0.05)。结论左西孟旦治疗无症状左室收缩功能异常伴心肌梗死疗效显著,不良反应发生率低,值得临床推广。

Objective To discuss the clinical efficacy and safety of levosimendan in treatment of acute myocardial infarction （AMI） complicated by asymptomatic left ventricular systolic dysfunction. Methods AMI patients （n=148） received conservative treatment were chosen from the Department of Cardiology of the First People’s Hospital of Pingdingshan City from Feb. 2015 to Jan. 2017, and the randomly divided into control group and treatment group （each n=74）. The control group was given bayaspirin （orally, 300 mg/d）, pravastatin （orally, 20 mg/d） and clopidogrel （orally, 300 mg/d） for routine treatment of anti-platelet aggregation, anticoagulation, anti-ischemia and thrombolysis and additionally, given β-receptor blocker （orally, 50 mg-100 mg/time, twice a day）. The treatment group was, besides of the same therapy as that of control group, given additionally intravenous injection of levosimendan in loading dose （12 μg/kg） at first for≥10 min, and then continuous intravenous pumping [0.05 μg-0.2 μg/（kg·min）] for 24 h. The changes of heart rate （HR）, systolic blood pressure （SBP） and diastolic blood pressure （DBP） were observed before treatment and 7 d after treatment. The NYHA grades, and levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） and insulin-like growth factor-1 （IGF-1）, and left ventricular ejection fraction （LVEF）, left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV） and stroke volume （SV） were detected before treatment and 7 d after treatment. Results After treatment for 7 d, the difference in HR had statistical significance （P〈0.05）, but difference in SBP and DBP had no statistical significance （P〉0.05）. After treatment for 7 d, the difference in LVEF, SV, LVEDV and LVESV had statistical significance （P〈0.05）, and LVEF and SV were higher and LVEDV and LVESV were lower in treatment group than those in control group. After treatment for 7 d, the difference in NT-proBNP and IGF-1 had statistical significance （P〈0.05）. After treatment for 7 d, the difference in NYHA grades had statistical significance （P〈0.05）. The difference in occurrence of adverse reactions had no statistical significance （P〉0.05）. Conclusion Levosimendan is significantly effective in treatment of AMI complicated by asymptomatic left ventricular systolic dysfunction with lower incidence of adverse reactions, which is worth clinical promoting.