左西孟旦治疗急性心肌梗死并发心力衰竭的临床观察

Clinical observation of levosimendan in the treatment of acute myocardial infarction complicated with heart failure

目的观察左西孟旦治疗急性心肌梗死并发心力衰竭的疗效及其对患者左室射血分数(LVEF)、脑钠肽(BNP)等指标的影响。方法选择2018年11月—2020年11月南华大学附属长沙中心医院收治的急性心肌梗死并发心力衰竭患者66例为研究对象,依据随机数字表法分为联合组和常规组,每组33例。常规组采用常规药物治疗,联合组在常规药物治疗的基础上联合左西孟旦治疗,2组均治疗7 d。比较2组患者治疗前后QT离散度(QTd)、校正的QT离散度(QTcd)、室性心律失常指标(短暂室性心动过速次数、频发室性期前收缩次数)、心功能指标[LVEF、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)]、血压[收缩压(SBP)、舒张压(DBP)]、炎性因子指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、BNP]、治疗效果及不良反应。结果治疗7 d后,2组患者QTd、QTcd、LVESV、LVEDV、SBP、DBP均低于治疗前,短暂室性心动过速、频发室性期前收缩次数均少于治疗前,LVEF均高于治疗前,且联合组优于常规组(P<0.05或P<0.01);治疗7 d后,2组患者CRP、TNF-α、BNP水平均低于治疗前,且联合组低于常规组(P<0.01)。联合组患者治疗总有效率为96.97%,高于常规组的69.70%(χ^(2)=8.836,P=0.003);联合组患者不良反应总发生率为3.03%,常规组不良反应总发生率为9.09%,2组比较差异无统计学意义(χ^(2)=1.065,P=0.302)。结论左西孟旦治疗急性心肌梗死并发心力衰竭的效果较好,可进一步改善患者心功能,控制患者炎性因子水平,且具有良好的安全性,值得在临床治疗中积极使用。

Objective To observe the efficacy of leosimendan in the treatment of acute myocardial infarction complicated with heart failure and its effect on left ventricular ejection fraction(LVEF)and brain natriuretic peptide(BNP).Methods A total of 66 patients with acute myocardial infarction complicated with heart failure admitted to Changsha Central Hospital Affiliated to Nanhua University from November 2018 to November 2020 were selected as the research subjects,according to random number table method,they were divided into combined group and conventional group,33 cases in each group.The conventional group was treated with conventional drugs,and the combined group was treated with levosimendan on the basis of conventional drugs,both groups were treated for 7 days.QT dispersion(QTd),corrected QT dispersion(QTcd),ventricular arrhythmia indicators(frequency of transient ventricular tachycardia,frequency of frequent ventricular presystolic systole),cardiac function indicators[LVEF,left ventricular end systolic volume(LVESV),left ventricular end diastolic volume(LVEDV)],blood pressure[systolic pressure(SBP),diastolic blood pressure(DBP)],inflammatory factors[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),BNP],therapeutic effects and adverse reactions were compared between 2 groups before and after treatment.Results After 7 days of treatment,QTd,QTcd,LVESV,LVEDV,SBP and DBP in 2 groups were lower than before treatment,the frequency of transient ventricular tachycardia and frequent premature ventricular systole were less than before treatment,LVEF were higher than before treatment,and the combined group was better than the conventional group(P<0.05 or P<0.01).After 7 days of treatment,the levels of CRP,TNF-αand BNP in 2 groups were lower than before treatment,and the combined group was lower than the conventional group(P<0.01).The total effective rate in combinaed group was 96.97%,which was higher than that in conventional group(69.70%)(χ^(2)=8.836,P=0.003).The total incidence of adverse reactions was 3.03%in the combined group and 9.09%in the conventional group,and there was no significant difference between the two groups(χ^(2)=1.065,P=0.302).Conclusion Levosimendan has a good effect in the treatment of acute myocardial infarction complicated with heart failure,which can further improve the cardiac function of patients and control the level of inflammatory factors in patients.Moreover,it has a good safety and is worthy of active use in clinical treatment.