左西孟旦与米力农治疗老年难治性心力衰竭临床疗效比较

Clinical efficacy comparison of levosimendan and milrinone in the treatment of elderly patients with refractory heart failure

目的比较左西孟旦与米力农治疗老年难治性心力衰竭(心衰)的临床疗效。方法选取2016年7月-2017年6月在医院住院治疗的难治性心力衰竭患者120例,随机分为左西孟旦组和米力农组各60例。2组患者均开展常规药物治疗。左西孟旦组以左西孟旦(悦文)12.5 mg加入5%葡萄糖注射液45 ml稀释泵内24 h泵入。根据患者体质量和耐受情况可稍微减低或增加剂量。米力农组给予米力农负荷量50μg/kg静脉注射10 min,然后0.375μg/(kg·min)静脉泵入并持续72 h。用药7 d后观察2组临床疗效、BNP、超声心动图变化,同时观察2组不良反应发生及预后情况。结果左西孟旦组患者总有效率为80.00%高于米力农组的66.67%,差异有统计学意义(P<0.05)。治疗前2组患者的BNP、SV、LVEF比较差异无统计学意义(P>0.05),治疗后2组患者的指标均明显改善,且左西孟旦组患者的BNP低于米力农组,SV及LVEF指标均高于米力农组,差异有统计学意义(P<0.05或P<0.01)。2组不良反应发生率比较差异无统计学意义(P>0.05)。跟踪入选对象3个月,左西孟旦组再次住院率低于米力农组,差异有统计学意义(P<0.05)。2组病死率相比差异无统计学意义(P>0.05)。结论左西孟旦治疗难治性心力衰竭的效果明显优于米力农,且3个月内的住院率较低,值得临床推广应用。

Objective To compare the clinical efficacy of levosimendan and milrinone in the treatment of elderly patients with refractory heart failure,it provides a theoretical basis for clinical treatment of refractory heart failure. Methods Selected 120 patients with intractable heart failure in the hospital from July 2016 to June 2017,and randomly divided into levosimendan group and milrinone group,each of 60 cases. Both groups of patients underwent routine drug treatment. Levosimendan group was pumped into levosimendan(yuewen）,and the yuewen 12. 5 mg was added to 45 ml of 5% glucose injection and diluted into the pump and pumped for 24 hours. The dose may be slightly reduced or increased depending on the patient＇ s body mass and tolerability. In milrinone group,50 μg/kg milrinone was intravenously injected for 10 min,and then 0. 375μg/(kg·min） was intravenously pumped for 72 h. After 7 days of treatment,the clinical efficacy,BNP and echocardiographic changes were observed in both groups. At the same time,the incidence of adverse reactions and the prognosis of two groups were observed. Results The total effective rate of patients in levosimendan group was 80. 00% higher than that in milrinone group(66. 67%）,and the difference was statistically significant(P〈0. 05）. There was no significant difference in BNP,SV and LVEF between two groups before treatment(P〉0. 05）. After treatment,the indexes of two groups of patients were significantly improved,and the BNP of the patients of levosimendan group was lower than that of milrinone group. The SV and LVEF indicators of levosimendan group were higher than those of milrinone group,and the difference was statistically significant(P〈0. 05 or P〈0. 01）. There was no significant difference in the incidence of adverse reactions between two groups(P〉0. 05）.After tracking the selected subjects for 3 months,the rate of re-hospitalization in levosimendan group was lower than that milrinone group,and the difference was statistically significant(P〈0. 05）. There was no significant difference in the mortality rate between two groups(P〉0. 05）. Conclusion The effect of levosimendan on obstinate heart failure is significantly better than that of milrinone,and the hospitalization rate within 3 months is low,which is worthy of clinical application.