左西孟旦对射血分数降低的心力衰竭患者心肾功能影响

Effect of levosimendan on cardiac and renal function in heart failure patients with reduced ejection fraction

目的:探讨左西孟旦对射血分数降低的心力衰竭患者心肾功能的影响。方法:回顾性分析2018年1—6月,首都医科大学附属北京安贞医院收治的41例射血分数下降的急性心力衰竭患者基础信息,均静脉泵入左西孟旦。同时收集使用左西孟旦治疗前及治疗后的心率、血压、B型脑钠肽、左室射血分数、肌酐、尿素、尿酸及钠钾电解质等指标,并进行统计分析,观察使用左西孟旦治疗前后心功能、肾功能及电解质的改变情况。结果:41例急性心力衰竭患者使用左西孟旦治疗1~2 d后收缩压明显低于治疗前[(102.83±14.72)mmHg vs.(109.40±13.68)mmHg],7 d后的B型钠尿肽明显降低[(651.84±899.27)pg·ml^-1vs.(1406.38±1333.71)pg·ml^-1],左室射血分数明显升高[(32.71±11.63)% vs.(26.87±8.05)%],尿酸水平明显降低[(449.19±154.86)μmol·L^-1 vs.(529.50±147.21)μmol·L^-1],差异均有统计学意义(P=0.040、0.012、0.014、0.030);肾小球滤过率[(73.63±21.46)mL·(min·1.73 m^2)^-1 vs.(82.71±20.13)mL·(min·1.73 m^2)^-1]和血肌酐[(98.02±24.81)mg·dL^-1 vs.(86.98±18.07)mg·dL^-1]均无明显变化,差异无统计学意义(P=0.76、0.22)。结论:左室射血分数下降的急性心力衰竭患者使用左西孟旦治疗5~7 d后可明显提高左室射血分数、降低B型钠尿肽和血尿酸的水平,但对肾功能无明显改善作用;使用左西孟旦24 h后,收缩压明显降低。

Objective To investigate the effect of levosimendan on cardiac and renal function in heart failure patients with lower ejection fraction. Methods The basic information of 41 acute heart failure patients with decreased ejection fraction admitted to Beijing Anzhen Hospital from January to June 2018 were retrospectively analyzed.All patients received levosimendan intravenously.The heart rate,blood pressure,B-type brain natriuretic peptide,left ventricular ejection fraction,creatinine,urea,uric acid,and sodium potassium electrolyte were collected before and after levosimendan treatment.The changes of cardiac function,renal function,and electrolyte were observed before and after levosimendan treatment. Results The systolic blood pressure of all the 41 patients with acute heart failure treated with levosimendan for 1-2 days was significantly lower than that before treatment[(102.83±14.72)mmHg vs.(109.40±13.68)mmHg].After 7 days,the B-type natriuretic peptide decreased significantly[(651.84±899.27)pg·ml^-1 vs.(1406.38±1333.71)pg·ml^-1],the left ventricular ejection fraction increased significantly[(32.71±11.63)% vs.(26.87±8.05)%],and the uric acid level decreased significantly [(449.19±154.86)μmol·L^-1 vs.(529.50±147.21)μmol·L^-1],the differences were statistically significant (P=0.040,0.012,0.014,0.030). The glomerular filtration rate[(73.63±21.46)mL·(min·1.73 m^2)^-1 vs.(82.71±20.13) mL·(min·1.73 m^2)^-1]and creatinine[(98.02±24.81)mg·dL^-1 vs.(86.98±18.07)mg·dL^-1]had no significant difference(P=0.76,0.22). Conclusion The left ventricular ejection fraction of acute heart failure patients with decreased left ventricular ejection fraction was significantly increased,and the level of B-type natriuretic peptide and serum uric acid was decreased after 5 to 7 days of levosimendan treatment.The renal function was not significantly improved,and the systolic blood pressure was significantly decreased after 24 hours of levosimendan treatment.