左西孟旦治疗老年慢性心力衰竭急性加重患者的临床疗效

Clinical Effect of Levosimendan in Treating Elderly Patients with Acute Exacerbation of Chronic Heart Failure

目的观察左西孟旦治疗老年慢性心力衰竭急性加重患者的临床疗效。方法选取2015年1月—2017年1月上海中医药大学附属上海市中西医结合医院收治的老年慢性心力衰竭急性加重患者195例,采用随机数字表法分为对照组97例和试验组98例。对照组患者给予常规抗心力衰竭治疗,试验组患者在对照组基础上加用左西孟旦治疗。比较两组患者治疗后1、2周临床疗效,治疗前及治疗后1、2周心功能指标,治疗期间不良反应发生情况;治疗后随访1年,比较两组患者再住院率及病死率。结果治疗后1周,试验组患者临床疗效优于对照组(P<0.05);治疗后2周,两组患者临床疗效比较,差异无统计学意义(P>0.05)。两组患者治疗前血浆N末端脑钠肽前体(NT-proBNP)水平、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)比较,差异无统计学意义(P>0.05);试验组患者治疗后1周血浆NT-proBNP水平低于对照组(P<0.05);两组患者治疗后2周血浆NT-proBNP水平及治疗后1、2周LVEF、LVEDD比较,差异无统计学意义(P>0.05)。两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。随访1年,试验组患者再住院率低于对照组(P<0.05);两组患者病死率比较,差异无统计学意义(P>0.05)。结论在常规抗心力衰竭治疗基础上加用左西孟旦能有效改善老年慢性心力衰竭急性加重患者短期临床疗效及心功能,降低再住院率,且安全性较高。

Objective To observe the clinical effect of levosimendan in treating elderly patients with acute exacerbation of chronic heart failure. Methods A total of 195 elderly patients with acute exacerbation of chronic heart failure were selected in Shanghai Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,and they were divided into control group（n=97）and test group（n=98）according to random number table. Patients in control group received routine anti-heart failure therapy,while patients in test group received levosimendan based on that of control group. Clinical effect 1 week and 2 weeks after treatment,index of cardiac function before treatment,1 week and 2 weeks after treatment,incidence of adverse reactions during treatment,re-hospitalization rate and fatality rate during 1-year follow-up after treatment were compared between the two groups. Results Clinical effect in test group was statistically significantly better than that in control group 1 week after treatment（P〈0.05）;while no statistically significant differences of clinical effect was found between the two groups 2 weeks after treatment（P〈0.05）. No statistically significant differences of plasma NT-proBNP level,LVEF or LVEDD was found between the two groups before treatment,nor was plasma NT-proBNP level 2 weeks after treatment,LVEF or LVEDD 1 week or 2 weeks after treatment（P〈0.05）,while plasma NT-proBNP level in test group was statistically significantly lower than that in control group 1 week after treatment（P〈0.05）. No statistically significant differences of incidence of adverse reactions was found between the two groups during treatmen（tP〈0.05）.During the 1-year follow-up after treatment,re-hospitalization rate in test group was statistically significantly lower than that in control group（P〈0.05）,while no statistically significant differences of fatality rate was found between the two groups（P〈0.05）. Conclusion Based on routine anti-heart failure therapy,levosimendan can effectively improve the short-term clinical effect and cardiac function in elderly patients with acute exacerbation of chronic heart failure,reduce the re-hospitalization rate,with relatively high safety.