左西孟旦联合多巴胺对顽固性心力衰竭患者心功能及心肌损伤的影响

Effect of Levosimendan combined with dopamine on the cardiac function and myocardial injury in patients with refractory heart failure

目的探讨左西孟旦联合多巴胺对顽固性心力衰竭(RHF)患者心功能及心肌损伤的影响。方法回顾性选取2016年6月至2018年6月北京市海淀医院收治的RHF患者100例,按治疗方法将患者分为左多组和单多组,每组各50例。单多组给予多巴胺治疗,左多组在此基础上给予左西孟旦治疗。比较两组患者的心功能[左心室射血分数(LVEF)、每搏排血量(SV)、心脏指数(CI)]、心肌指标[氨基末端脑钠肽前体(NT-proBNP)、心肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)]、临床疗效和不良反应。结果左多组和单多组患者治疗后LVEF[(50.58±5.61、43.41±4.42)%]、SV[(72.52±7.61、66.21±6.46)ml]、CI[(5.13±0.48、3.63±0.46)L/(min·m^2)]明显高于治疗前的[(35.39±3.46、35.69±3.70)%、(55.01±5.63、55.35±5.65)ml、(2.11±0.48、2.14±0.45)L/(min·m^2)],左多组治疗后LVEF、SV、CI明显高于单多组,差异具有统计学意义(P<0.05);左多组和单多组患者治疗后NT-proBNP[(5312.25±532.45、6515.64±650.58)ng/L]、cTnT[(18.18±2.45、26.23±3.64)ng/L]、CK-MB[(10.33±2.12、16.87±2.56)U/L]明显低于治疗前[(26442.22±2853.52、26216.68±2854.56)ng/L、(68.76±7.52、67.98±7.43)ng/L、(36.74±4.36、37.11±4.41)U/L],左多组患者治疗后NT-proBNP、cTnT、CK-MB明显低于单多组,差异具有统计学意义(P<0.05);左多组患者治疗有效率为94.00%明显高于单多组的80.00%,差异具有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论左西孟旦联合多巴胺可有效改善RHF患者心功能及心肌损伤,有利于提高临床疗效,且安全性好,值得临床推广应用。

Objective To discuss the effect of Levosimendan combined with Dopamine on the cardiac function and myocardial injury in patients with refractory heart failure (RHF). Methods 100 patients with RHF were retrospectively selected from June 2016 to June 2018 in Beijing Haidian Hospital,according to the random number table method,they were divided into left multi-group and single multi-group,50 cases in each group. The single multi-group was given Dopamine treatment,the left multi-group was given Levosimentan treatment on the basis. The cardiac function [left ventricular ejection fraction (LVEF),stroke volume (SV),cardiac index (CI)],myocardial injury [precursor of amino-terminal brain natriuretic peptide (NT-proBNP),cardiac troponin T (cTnT),creatine kinase isoenzyme (CK-MB)],clinical efficacy,adverse reactions were compared between the two groups. Results The LVEF [(50.58±5.61,43.41±4.42)%],SV[(72.52±7.61,66.21±6.46) ml],CI [(5.13±0.48,3.63±0.46) L/(min·m^ 2)] after treatment in the left multi-group and the single multi-group were significantly higher than those before treatment [(35.39±3.46,35.69±3.70)%,(55.01±5.63,55.35±5.65) ml,(2.11±0.48,2.14±0.45) L/(min·m ^2)],the LVEF,SV,CIin the left multi-group after treatment were significantly higher than those in the single multi-group,the difference was statistically significant ( P <0.05). The NT-proBNP [(5 312.25±532.45,6 515.64±650.58) ng/L],cTnT [(18.18±2.45,26.23±3.64) ng/L],CK-MB [(10.33±2.12,16.87±2.56) U/L] after treatment in the left multi-group and the single multi-group were significantly lower than those before treatment [(26 442.22±2 853.52,26 216.68±2 854.56) ng/L,(68.76±7.52,67.98±7.43) ng/L,(36.74±4.36,37.11±4.41)U/L],the NT-proBNP,cTnT,CK-MB after treatment in the left multi-group were significantly lower than those in the single multi-group,the difference was statistically significant ( P <0.05). The treatment effective rate in the left multi-group was 94.00%,which was significantly higher than that in the single multi-group (80.00%),the difference was statistically significant ( P <0.05). The comparison of the adverse reaction rate between the left multi-group and the single multi-group,the difference was not statistically significant ( P >0.05). Conclusion Levosimentam combined with Dopamine can effectively improve the cardiac function and myocardial injury in patients with RHF,which is conducive to improving the therapeutic efficacy,and it has the safety. It's worth for further clinical promotion.