左西孟旦对老年射血分数保留型心力衰竭急性加重期患者的疗效

Efficacy of levosimendan in treatment of acute exacerbation of heart failure with preserved ejection fraction in the elderly

目的探讨左西孟旦对老年射血分数保留型心力衰竭(HFpEF)急性加重期患者的治疗效果。方法回顾性分析2016年1月至2019年12月于空军军医大学第一附属医院收治住院的52例HFpEF急性加重期病例的临床资料。根据是否接受了左西孟旦治疗将患者分为左西孟旦治疗组(26例)和对照组(26例),比较2组患者治疗1周后纽约心脏病协会(NYHA)心功能分级改善率(有效率),3、12个月内再住院率及治疗前后N末端脑钠肽前体(NT-proBNP)水平变化。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验、Wilcoxon秩和检验、χ^(2)检验或Fisher确切概率法检验进行组间比较。结果治疗1周后左西孟旦治疗组有效率显著高于对照组,3个月内再住院率显著低于对照组,差异均有统计学意义(P<0.05);12个月内2组再住院率比较,差异无统计学意义(P>0.05);治疗后2组NT-proBNP水平均显著降低(P<0.05),但组间降幅差异无统计学意义(P>0.05);NT-proBNP水平降低30%以上的比例比较,差异无统计学意义(P>0.05)。结论应用左西孟旦治疗老年HFpEF急性加重期患者,可明显减轻患者心力衰竭症状,改善心功能分级,降低短期内再住院风险,效果较好,安全性较高,而对远期再住院风险无显著影响。

Objective To investigate the therapeutic effectiveness of levosimendan on acute exacerbation of heart failure with preserved ejection fraction(HFpEF)in the elderly.Methods A retrospective analysis was carried out in 52 elderly patients with acute exacerbation of HFpEF admitted to the First Affiliated Hospital of Air Force Medical University from January 2016 to December 2019.The patients were divided into the levosimendan treatment group(26 cases)and the control group(26 cases)according to whether they received levosimendan therapy.The improvement of New York Heart Association(NYHA)cardiac function classification(effective rate)1 week after treatment,the rehospitalization rates within 3 and 12 months,and the changes of N-terminal pro-brain natriuretic peptide(NT-proBNP)before and after treatment were compared between the 2 groups.SPSS statistics 19.0 was used for data analysis.According to the distribution type,student′s t test,Wilcoxon rank sum test,Chi-square test or Fisher exact probability test was performed for intergroup comparison.Results Compared with the control group,the levosimendan group had significantly higher effective rate after 1 week treatment(P<0.05)and lower readmission rate within 3 months(P<0.05).There was no statistical difference in the readmission rate within 12 months between the 2 groups(P>0.05).After treatment,the NT-proBNP levels were significantly decreased in both groups(P<0.05),but the difference was not statistically significant(P>0.05).After treatment,the proportion of patients whose NT-proBNP level was decreased by more than 30%in the two groups were compared,but no statistical difference was observed between the 2 groups(P>0.05).Conclusion Application of levosimendan in the treatment of acute exacerbation of HFpEF in the elderly can significantly alleviate the symptoms of heart failure,improve the heart function and reduce short-term readmission risk,with high safety,but has no obvious effect on long-term readmission risk.