国产左西孟旦与多巴酚丁胺治疗急性失代偿性心力衰竭患者血液动力学和疗效对比观察  

Hemodynamic and efficacies of domestic levosimendan versus dobutamine in patients with acutedecompensated heart failure

作　　者：张宇辉[1] 卿恩明[2] 张健[1] 黄燕[1] 吕蓉 周琼[1] 韦丙奇[1] 安涛[1] 卿平[1] 邹长虹[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院,100037 [2]首都医科大学附属北京安贞医院麻醉科

出　　处：《中华医学杂志》2012年第8期555-558,共4页National Medical Journal of China

摘　　要：目的 对比国产左西孟旦注射液和多巴酚丁胺治疗急性失代偿性心力衰竭（ADHF）的血液动力学和疗效.方法 采用多中心,随机、双盲、阳性药物对照方法.入选ADHF患者接受Swan-Ganz导管检查后满足肺毛细血管楔压（PCWP）≥15 mm Hg、心脏指数（CI）≤2.5 L· min-1·m-2者分入左西孟旦组和多巴酚丁胺组,均静脉滴注24h.结果 78例ADHF患者分入左西孟旦组和多巴酚丁胺组（各39例）.左西孟旦组治疗后24h的PCWP较基线水平显著降低[（14.2±7.6）mm Hg比（23.1±8.0） mm Hg,P＜0.01],CI较基线水平显著增加[（2.8±0.7）L·min-1·m-2比（2.0±0.4）L·min-1· m-2,P＜0.01].与多巴酚丁胺组比较,PCWP,肺动脉平均压（PAMP）,体循环阻力（SVR）在治疗24 h后较基线水平变化率（中位数）在左西孟旦组显著降低45.5％比22.0％,（P＜0.05）；20.8％比15.0％,（P＜0.05）；34.5％比12.7％,（P＜0.01）；CI升高39.8％比13.5％,（P＜0.01）.治疗24h后,左西孟旦组LVEF较基线显著升高（32.5％±8.7％比27.4％±6.1％,P＜0.05）.治疗后N末端B型利钠肽原水平与PCWP和CI均显著相关（r=0.31,P＜0.01；r=-0.29,P＜0.05）.左西孟旦组呼吸困难改善较多巴酚丁胺组显著.不良事件和不良反应发生率两组差异无统计学意义.结论 与多巴酚丁胺比较,国产左西孟旦对ADHF患者具有更好改善血液动力学和呼吸困难的作用,耐受性和安全性良好.Objective To compare the hemodynamic effects of domestic levosimendan versus dobutamine on patients with acute decompensated heart failure （ADHF）.Methods A total of 78 ADHF patients with pulmonary capillary wedge pressure （PCWP） ≥ 15 mm Hg and cardiac index （CI） ≤ 2.5L · min-1 · m-2 were enrolled into this blind,positive-controlled,randomized and multicenter study to receive 24 h intravenous levosimendan or dobutamine therapy. They were randomized into 2 groups：levosimendan and dobutamine （ n =39 each）. Results In the levosimendan group,the PCWP 24 h decreased significantly （ （ 14.2 ＋ 7.6） vs （ 23.1 ＋ 8.1 ） mm Hg,P 〈 0.01 ） and CI increased significantly versus the baseline levels （ （2.8 =0.7） L · min -1 · m-2 vs （2.0 ±0.4） L · min -1 · m-2, P 〈0.01 ）.As compared with the dobutamine group,the change percentages versus baseline in PCWP,pulmonary arterialmean pressure （PAMP）,systemic vascular resistance （SVR） at 24 h （median）decreased or increased significantly in the levosimendan group 45.5% vs 22.1% （ P 〈 0.05 ） ; 20.8% vs 15.0% （ P 〈 0.05 ） ;34.5% vs12.7% （P〈0.01）; CI increased 39.8% vs 13.5% （P〈0.01）.As compared with the baseline level,LVEF increased at 24 h in the levosimendan group （27.4% ＋6.1% vs 32.5% ＋ 8.7%,P 〈0.05）.Both PCWP and CI at 24 h correlated significantly with NT-proBNP at Day 3 （r=0.31,P 〈 0.01 ; r =- 0.29,P 〈 0.05）.Dyspnea improved greatly at 24 h in the levosimendan group than that in the dobutamine group.Conclusion As compared with dobutamine,domestic levosimendan may bring about better outcomes of hemodynamics and dyspnea.

关 键 词：心力衰竭 血液动力学 左西孟旦 多巴酚丁胺 

分 类 号：R541.6[医药卫生—心血管疾病]