左西孟旦联合重组人脑利钠肽对ADHF患者的心功能及血流动力学的影响

Effects of Levosimendan Combined with Recombinant Human Brain Natriuretic Peptide on Cardiac Function and Hemodynamics in Patients with Acute Decompensated Heart Failure

目的探讨左西孟旦联合重组人脑利钠肽对急性失代偿性心力衰竭(ADHF)患者的心功能及血流动力学的影响。方法将112例ADHF患者按治疗方案的不同分为对照组和观察组,每组56例。2组均给予常规治疗,同时给予冻干重组人脑利钠肽治疗。在此基础上,观察组给予左西孟旦注射液治疗。观察2组治疗前、治疗48 h后的心功能指标[每搏输出量(SV)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]、血流动力学指标[体循环血管阻力(SVR)、肺毛细血管楔压(PCWP)、肺动脉平均压(PAMP)、右心房压(RAP)]、心率(HR)、呼吸频率(RR)、24 h尿量和血浆B型脑钠肽(BNP)的水平及治疗期间不良反应发生情况。结果观察组治疗48 h后SV、LVEF水平均较对照组升高,HR、RR和SVR、PCWP、PAMP及血浆BNP水平均较对照组降低,24 h尿量较对照组增多(均P<0.05)。观察组出现血钾轻度降低、室性心动过速各1例;对照组出现皮疹1例,轻度腹泻2例;均经对症处理后好转。结论左西孟旦联合重组人脑利钠肽治疗ADHF能显著改善患者的心功能和血流动力学,且安全性高。

Objective To explore the effects of levosimendan combined with recombinant human brain natriuretic peptide on cardiac function and hemodynamics in patients with acute decompensated heart failure(ADHF). Methods A total of 112 patients with ADHF received conventional treatment.In addition,these patients were given freeze-dried recombinant human brain natriuretic peptide alone(control group, n =56) or in combination with levosimendan injection(observation group, n =56).Cardiac function indexes(stroke output(SV),left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVEDD)),hemodynamic parameters(systemic vascular resistance(SVR),pulmonary capillary wedge pressure(PCWP),pulmonary arterial pressure(PAMP) and right atrial pressure(RAP)),heart rate(HR),respiratory rate(RR),24-hour urine volume,and plasma B-type brain natriuretic peptide level(BNP) were measured before and after treatment for 48 hours.Furthermore,the occurrence of adverse reactions during treatment was observed in both groups. Results After 48 hours of treatment,compared with control group,SV,LVEF and 24-hour urine volume increased but HR,RR,SVR,PCWP,PAMP and plasma BNP level decreased in observation group( P <0.05).In observation group,slight decrease in blood potassium occurred in 1 patient and ventricular tachycardia in 1 patient.In control group,rash was found in 1 patient and mild diarrhea in 2 patients.The symptoms were improved after symptomatic treatment in both groups. Conclusion Levosimendan combined with recombinant human brain natriuretic peptide can effectively and safely improve cardiac function and hemodynamics in patients with ADHF.