不同剂量左西孟旦治疗老年重症心力衰竭患者的疗效比较

Clinical efficacy of different doses of levosimendan in the treatment of elderly patients with severe heart failure

目的比较不同剂量左西孟旦治疗老年重症心力衰竭患者的临床疗效。方法选取2019年1月-2022年2月厦门大学附属第一医院收治的129例老年重症心力衰竭患者,按照随机数字表法分为A、B、C组,每组43例,治疗4周后失访3例,A、B、C组最终分别纳入41例、42例、43例。A、B、C组患者均接受左西孟旦治疗,用药剂量分别为0.2、0.3、0.4μg·kg^(-1)·min^(-1),持续治疗4周。比较3组治疗前及治疗4周后心功能指标[心肌做功指数(MPI)、左心室射血分数(LVEF)、每搏输出量(SV)、心脏指数(CI)]、心肌细胞凋亡指标[可溶性凋亡相关因子(sFAS)、可溶性凋亡相关因子配体(sFASL)]、血流动力学指标[平均动脉压(MAP)、心率(HR)]及不良反应。结果治疗4周后,3组MPI低于治疗前,LVEF、SV、CI高于治疗前,且C组降低/升高幅度大于A、B组(P<0.05);3组血清sFAS、sFASL水平及HR低于治疗前,MAP高于治疗前,且C组降低/升高幅度大于A、B组(P<0.05)。A、B、C组不良反应总发生率比较,差异无统计学意义(19.51%vs.28.56%vs.41.87%,χ^(2)=5.052,P=0.080)。结论相较于小剂量、中等剂量用药,大剂量左西孟旦治疗老年重症心力衰竭患者可更有效地抑制心肌细胞凋亡,减轻心肌损伤,维持血流动力学稳定,进而提高心功能,且安全性较高。

Objective To investigate the clinical efficacy of different doses of levosimendan in the treatment of elderly patients with severe heart failure.Methods A total of 129 cases of elderly patients with severe heart failure admitted to the First Affiliated Hospital of Xiamen University from January 2019 to February 2022 were selected,and they were divided into groups A,B and C according to random number table method,with 43 cases in each group.A total of 3 cases were lost after 4 weeks of treatment,ending with 41,42 and 43 cases in groups A,B and C,respectively.Patients in groups A,B and C were treated with levosimendan at doses of 0.2,0.3,0.4μg·kg^(-1)·min^(-1),respectively,all groups were treated for 4 weeks.Cardiac function indexes(MPI,LVEF,SV,CI),cardiomyocyte apoptosis indexes(sFAS,sFASL),hemodynamic indexes(MAP,HR)before and after 4 weeks of treatment,and incidence of adverse reactions were compared among the three groups.Results After 4 weeks of treatment,MPI among the three groups was lower than that before treatment,LVEF,SV,CI were higher than those before treatment,and the decrease/increase of indexes of the group C were greater than those of groups A,B(P<0.05);Serum levels of sFAS,sFASL and HR among the three groups were lower than those before treatment,MAP was higher than that before treatment,and the decrease/increase of indexes of the group C were greater than those of groups A,B(P<0.05).There was no significant difference of incidence of adverse reactions among the groups A,B,C(19.51%vs.28.56%vs.41.87%,χ^(2)=5.052,P=0.080).Conclusion Compared with low-dose and mild-dose of levosimendan,high-dose of levosimendan is more effective in inhibiting cardiomyocyte apoptosis,reducing myocardial injury,stabilizing hemodynamics in the treatment of elderly patients with severe heart failure,then improving cardiac function,and with higher safety.