左西孟旦、硝酸甘油及多巴酚丁胺治疗急性失代偿心力衰竭的临床疗效比较

Comparison in clinical efficacy among levosimendan, nitroglycerin and dobutamine in treatment of acute decompensated heart failure

目的分析左西孟旦(LEV)、硝酸甘油(NTG)及多巴酚丁胺(DOB)对急性失代偿心力衰竭(ADHF)患者心功能及肾功能的影响。方法选取青海省心脑血管病专科医院2017年1月至2018年4月期间收治的210例ADHF患者为研究对象。所有患者均给予抗凝、抗血小板、降脂、吸氧、镇静等常规基础治疗。根据随机数字表法分为DOB组(静脉输注DOB,n=70)、NTG组(静脉输注NTG,n=70),LEV组(静脉输注LEV,n=70)。治疗72 h后,比较3组患者射血分数(LVEF),N端前脑钠肽(NT-proBNP),6分钟步行实验(6MWD),超敏C反应蛋白(hs-CRP),肌钙蛋白(cTnI)及肾功能指标包括肾小球滤过率(GFR),血尿素氮(BUN),血肌酐(Scr),血清胱抑素(Cys-C)及尿量等指标表达情况。结果治疗前,3组患者LVEF、NT-proBNP、6MWD及hs-CRP、cTnI水平比较,差异均无统计学意义(P>0.05)。治疗后,3组患者的LVEF、6MWD及hs-CRP水平较治疗前均明显升高,差异均有统计学意义(P<0.05);NT-proBNP及cTnI水平较治疗前均明显降低,差异亦均有统计学意义(P<0.05)。治疗后,NTG组、DOB组及LEV组患者LVEF水平、6MWD及hs-CRP水平依次增高,NTproBNP及cTnI水平依次降低,组间相比差异均具有统计学意义(P<0.05)。治疗前,3组患者GFR、BUN、Scr、Cys-C及72 h尿量比较,差异均无统计学意义(P>0.05)。治疗后,NTG组、DOB组上述指标与治疗前比较,差异均无统计学意义(P>0.05);而LEV组治疗后GFR及72 h尿量高于治疗前,BUN、Scr、Cys-C低于治疗前,差异均具有统计学意义(P均<0.05)。结论与硝酸甘油及多巴酚丁胺治疗相比,左西孟旦更能改善ADHF患者心功能及肾功能。

Objective To analyze the influence of levosimendan(LEV),nitroglycerin(NTG)and dobutamine(DOB)on heart function and kidney function in patients with acute decompensated heart failure(ADHF).Methods ADHF patients(n=210)were chosen from Specialist Hospital of Cardiovascular and Cerebrovascular Diseases in Qinghai Province from Jan.2017 to Apr.2018.The patients were divided,according to random digital table,into DOB group(with intravenous drip of DOB),NTG group(with intravenous drip of NTG)and LEV group(with intravenous drip of LEV,each n=70).The indexes of left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP),6-minute walk distance(6MWD),high sensitivity C-reactive protein(hs-CRP),cardiac troponin I(cTnI),glomerular filtration rate(GFR),blood urea nitrogen(BUN),serum creatinine(SCr),serum cystatin C(Cys C)and urine volume were compared among 3 groups after treatment for 72 h.Results Before treatment,the comparison in LVEF,NT-proBNP,6MWD,and levels hs-CRP and cTnI showed that the difference had no statistical significance among 3 groups(P>0.05).After treatment,LVEF,6MWD and hs-CRP level increased significantly(P<0.05),and levels of NT-proBNP and cTnI decreased significantly(P<0.05)in 3 groups compared with those before treatment.After treatment,LVEF level,6MWD and hs-CRP level ascended successively,and levels of NT-proBNP and cTnI descended successively in NTG group,DOB group and LEV group(P<0.05).Before treatment,the comparison in GFR,BUN,Scr,Cys-C and 72-h urine volume showed that the difference had no statistical significance among 3 groups(P>0.05).After treatment,the difference in above indexes had no statistical significance in NTG group and DOB group(P>0.05)compared with those before treatment.In LEV group,GFR and 72-h urine volume were higher,and levels of BUN,Scr and Cys-C were lower after treatment than those before treatment(all P<0.05).Conclusion LEV has higher improving effect on heart function and kidney function compared with NTG and DOB in ADHF patients.