丹参多酚酸盐联合左西孟旦治疗冠心病合并心力衰竭的临床疗效及安全性观察

Effects of salvianolic polyphenol combined with levosimendan on cardiac function,oxidative stress and hemodynamics in patients with coronary heart disease and heart failure

目的探究丹参多酚酸盐联合左西孟旦对冠心病合并心力衰竭患者心功能、氧化应激及血流动力学的影响。方法将2019年1月—2021年1月扬州大学医学院附属沭阳医院156例冠心病合并心力衰竭患者随机分为左西孟旦组(n=77)、联合治疗组(n=79),两组患者均连续治疗28 d。治疗结束2周后按照美国纽约心脏病协会(NYHA)标准进行心功能分级以并比较判定疗效;比较两组治疗前后心功能参数[左室收缩末期容积(LVESV)、左室舒张末期内径(LVEDV)、左室射血分数(LVEF)]、氧化应激水平[超氧化物歧化酶(SOD)活性、硫代巴比妥酸比色法检测丙二醛(MDA)、铁离子还原法检测活性氧簇(ROS)]及血流动力学参数(全血高切黏度、全血低切黏度、血浆黏度)水平变化;比较两组不良反应发生情况。结果治疗后联合治疗组患者总有效率高于左西孟旦组(P<0.05);治疗后联合治疗组患者LVESV、LVEDV及MDA、ROS及全血高切黏度、全血低切黏度、血浆黏度水平均低于左西孟旦组(P<0.05),LVEF、SOD水平高于左西孟旦组(P<0.05);治疗期间两组不良反应发生率差异无统计学意义(P>0.05)。结论丹参多酚酸盐联合左西孟旦治疗冠心病合并慢性心力衰竭能够明显降低氧化应激反应程度及血液黏度,促进心功能恢复,疗效较高且安全可靠,值得临床推广。

Objective To investigate the effects of salvianolic polyphenol combined with levosimendan on heart function,oxidative stress and hemodynamics in patients with coronary heart disease complicated with heart failure.Methods 77 patients(levosimendan group)with coronary heart disease and heart failure underwent intravenous drip of levosimendan by the rate of 0.05μg/(kg·min)for 6~24 h and such treatment was repeated once 14 d later.Another 79 patients with coronary heart disease and heart failure underwent intravenous drip oflevosimendan as described above and intravenous drip of salvianolate 250 mg once a day in addition for 28 d(combined therapy group).Two weeks later cardiac functional grading was conducted based on the standard of New York Heart Association.Medical ultrasonic equipment was used to measure the parameters of heart function:left ventricular end-systolic volume(LVESV),left ventricular end diastolic diameter(LVEDV),and left ventricular ejection fraction(LVEF).Automatic blood rheometer was used to test the levels of haemorheologic indices:whole blood high shear viscosity,whole blood low shear viscosity,and plasma viscosity.Fasting peripheral venous blood samples were collected before and 2 weeks after treatment to test the levels of superoxide dismutase(SOD)and malondialdehyde(MDA)by thiobarbituric acid colorimetry,and reactive oxygen species(ROS)iron ion reduction method.The incidence of adverse reaction was compared between the two groups.Results The total effective rate of combined treatment group was 92.40%,significantly higher than that of the simendan group(74.3%,P<0.05).The levels of LVESV,LVEDV,MDA,ROS,high shear viscosity of whole blood,low shear viscosity of whole blood and plasma viscosity of the combined treatment group were all significantly lower than those of the left simendan group(all P<0.05),and the levels of LVEF and SOD of the combined treatment group were both significantly higher than those of the left simendan group(both P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P<0.05).Conclusion Safe and reliable,salvianolic polyphenol combined with levosimendan in the treatment of coronary heart disease complicated with chronic heart failure can effectively reduces the degree of oxidative stress and blood viscosity,improveshemodynamics and promotes the recovery of heart function.