左西孟旦治疗高龄顽固性心力衰竭的疗效

Clinical Effect of levosimendan in the treatment of refractory heart failure in senile patients

目的观察左西孟旦(levosimendan)小剂量静脉维持治疗老年顽固性心力衰竭的疗效。方法心力衰竭36例,均为使用常规抗心力衰竭治疗效果欠佳者,给予左西孟旦小剂量持续静脉滴注(0.05~0.2)μg/(kg·min),观察使用左西孟旦的治疗效果及过程中出现的不良反应。结果 36例共46次使用左西孟旦,部分患者间断重复使用。经左西孟旦治疗72 h后,患者血管收缩压(systolic blood pressure,SBP)、血管舒张压(diastolic blood pressure,DBP)及心率(heart rate,HR)均较治疗前有所降低,无统计学差异(P>0.05);N-末端脑钠肽前体(N-terminal pro-type natriuretic peptide,NT-pro BNP)较治疗前显著降低(11785.22±10903.34 vs 5989.83±6044.02);左室射血分数(left ventricular ejection fraction,LVEF)、每博心输出量(stroke volume,SV)均较治疗前显著升高(35.11±4.21 vs 50.09±9.37)、(37.22±17.26 vs 69.90±34.62),差异均有统计学意义(P<0.05)。血肌酐(Cr)数值较治疗前有所降低(216.03±32.75 vs 137.43±29.07),无统计学差异(P>0.05);尿排出量与治疗前相比显著增多(1383.57±431.14 vs 1906.72±522.70),差异有统计学意义(P<0.05)。结论左西孟旦治疗老年顽固性心力衰竭患者疗效非常明显,可显著提高患者心脏功能及肾脏功能。

Objective To observe the clinical effect of levosimendan for treatment of refractory heart failure and mild renal dysfunction. Methods There were 36 heart failure patients on whom conventional heart failure therapies had poor effects. Each of these patients was given the continuous intravenous drip of levosimendan（ 0. 05 ～ 0. 2 μg/kg/min,according to the directions） to observe the effects and side effects. Results The 36 patients used levosimendan for a total of 46 times,but some of these patients took this medicine on and off. After 72 hours of treatment,levels of NT-pro BNP were significantly different（ 11785. 22 ± 10903. 34 vs5989. 83 ± 6044. 02,P〈0. 05）. LVEF and SV improved significantly in levosimendan group after treatment（ 35. 11 ± 4. 21 vs 50. 09± 9. 37; 37. 22 ± 17. 26 vs 69. 90 ± 34. 62,P〈0. 05）. After treatment,the level of Cr showed no significant difference（ 716. 02 ±342. 75 vs 137. 43 ± 79. 07,P〉0. 05）,but the volume of urine was increased significantly（ 1383. 57 ± 431. 14 vs 1906. 72 ± 522. 70,P〈0. 05）. Conclusions Levosimendan can further improve heart function in patients with refractory heart failure.