间歇应用左西孟旦治疗晚期心力衰竭患者疗效分析

The effect of intermittent infusion of levosimendan in advanced heart failure patients

目的分析间歇应用左西孟旦治疗晚期心力衰竭患者的疗效。方法入选2019年10月至2021年3月间于山西白求恩医院心脏重症监护室(CCU)住院的晚期心衰患者,采用随机数表法将研究对象按照1∶1比例分为试验组和对照组,对照组接受常规抗心衰方案治疗,试验组在常规治疗的基础上给予左西孟旦注射液静脉输注(初始负荷剂量12μg/kg静脉推注10 min,继以0.1~0.2μg·kg-1·min-1的剂量微量泵持续静脉注射24h),试验组间隔2周给药一次,共给药3次。比较两组治疗前与第二次治疗后7d、第三次治疗后7d时单光子发射计算机断层显像(SPECT)所测左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)及左心室舒张末期容积(LVEDV)、血浆N末端B型利钠肽原(NT-proBNP)等相关临床指标变化,比较治疗后随访3个月内心衰再住院率、心衰病死率的差异。结果本研究共纳入晚期心衰住院患者40例,试验组和对照组各20例。(1)与治疗前比较,试验组治疗后LVEF提高,LVESV、LVEDV及血浆NT-proBNP下降,差异有统计学意义(P均<0.05);对照组治疗后LVEF提高及血浆NT-proBNP下降,差异有统计学意义(P均<0.05),但LVESV及LVEDV的变化无统计学意义(P均>0.05)。(2)与对照组比较,试验组LVEF、LVESV、LVEDV及血浆NT-proBNP的改善程度均高于对照组,差异均有统计学意义(P均<0.05)。(3)试验组与对照组治疗后随访3个月时心衰再住院率及心衰病死率差异无统计学意义(P均>0.05)。结论左西孟旦治疗晚期心衰患者具有良好的临床疗效,能显著改善临床症状,提高LVEF,降低LVEDV、LVESV和NT-proBNP,对临床治疗具有一定的指导意义。

Objective To investigate the efficacy of levosimendan for patients with advanced heart failure(HF).Methods Advanced HF patients admitted to the Cardiac Intensive Care Unit of Shanxi Bethune Hospital from October 2019 to March 2021 were recruited and divided into the levosimendan group and the control group in a 1∶1 ratio by random number table method.The control group received conventional therapies for advanced HF.The levosimendan group was treated with conventional therapies plus intravenous infusion of levosimendan with an initial loading dose of 12μg/kg for 10 min followed by continuous intravenous infusion with a dose of 0.1-0.2μg·kg-1·min-1 for 24h,and administered once every 2 weeks for a total of 3 doses.Indicators for efficacy evaluation included left ventricular ejection fraction(LVEF),left ventricular end systolic volume(LVESV),left ventricular end diastolic volume(LVEDV)measured by single photon emission computed tomography(SPECT)and the level of plasma N-terminal pro-B type natriuretic peptide(NT-proBNP),etc.These parameters were evaluated before the treatment,7 days after the second treatment and 7 days after the third treatment.In addition,rate of HF rehospitalization and mortality during 3 months follow-up after treatment was compared between the two groups.Results A total of 40 advanced HF patients were included in the study,with 20 in the levosimendan group and 20 in the control group.(1)Compared with baseline leves,LVEF increased after treatment,LVESV,LVEDV and plasma NT-probNP decreased after three courses of treatment in the levosimendan group(all P<0.05).In the control group,LVEF increased and plasma NT-proBNP decreased after treatment(both P<0.05).However,the changes of LVESV and LVEDV were not statistically significant(both P>0.05).(2)There was greater significant improvement in LVEF,LVESV,LVEDV and plasma NT-proBNP in the levosimendan group than that in the control group(all P<0.05).(3)There was no significant difference in the rate of rehospitalization and morality of HF between these two groups after 3 months of follow-up(both P>0.05).Conclusion Levosimendan shows good clinical efficacy in the treatment of advanced HF patients.It can significantly improve clinical symptoms through increasing LVEF and decreasing LVEDV,LVESV and NT-proBNP,which has certain guiding significance for clinical treatment.