静脉注射桂哌齐特治疗重度失代偿性心力衰竭的疗效分析  

Efficacy and safety of intravenous cinepazide compared with dobutamine in patients with severe decompensated heart failure

作　　者：罗晓菡[1] 黄达民[1] 卢英民[1] 李宏松[1] 姚能才[1] 窦存芳[1] 石来新[1] 张金春[1] 季俭[1] 沈俊娴[1] 包敏敏[1] 宋蕾[1] 韦彩雯[1] 李毅刚[1] 

机构地区：[1]上海交通大学医学院附属新华医院(崇明)心内科,上海202150

出　　处：《临床心血管病杂志》2012年第11期861-864,共4页Journal of Clinical Cardiology

摘　　要：目的:评价对常规治疗效果不佳的重度失代偿性心力衰竭患者静脉注射桂哌齐特的有效性及安全性。方法:采用多中心、随机、平行、阳性药物对照临床研究,入选230例重度失代偿性心力衰竭患者,其中5例在试验开始前退出,其余225例随机分为试验组(120例)和对照组(105例)。试验组用桂哌齐特注射液以4μg.kg-1.min-1静脉滴注,持续23 h;对照组用多巴酚丁胺2μg.kg-1.min-1初始静脉滴注,1 h后增加到4μg.kg-1.min-1并持续23 h,综合评价药物的疗效和安全性。结果:试验组和对照组的临床有效率分别为31.67%(38/120)和18.10%(19/105)(P<0.01);治疗24 h后,试验组和对照组的左室射血分数均值上升分别为6.4%和4.5%(P>0.05),每搏心输出量均值上升分别为10.6 ml和2.5 ml(P<0.05);与对照组比较,试验组患者呼吸困难和全身临床状况有显著改善(23.33%:10.48%;6.67%:2.86%,均P<0.05)。试验组治疗前后平均血浆脑钠肽水平[(1 997±865)pg/ml:(384±114)pg/ml]和对照组治疗前后平均血浆脑钠肽水平[(1 879±202)pg/ml:(1 025±48)pg/ml]均差异有统计学意义(均P<0.01);治疗后,试验组与对照组平均血浆脑钠肽水平比较差异有统计学意义[(384±114)pg/ml:(1 025±48)pg/ml,P<0.01]。2组均未发生严重不良事件,试验组不良反应发生率显著低于对照组(13.33%:22.86%,P<0.05);试验组常见的不良反应为低血钾、低血压以及室性期前收缩等。结论:与多巴酚丁胺比较,桂哌齐特注射液治疗重度失代偿性心力衰竭疗效确切,安全性及耐受性良好。Objective：To compare the efficacy and safety of intravenous cinepazide and dobutamine to conventional medications in patients with severe decompensated heart failure refractory.Method：Two hundred and thirty patients were recruited into this multicentre,randomized,positive-controlled and parallel-group study to receive either cinepazide or dobutamine therapy,but 5 patients exited before the start of the trial.In the cinepazide group（n=120）,a continuous infusion of 4 μg·kg-1·min-1 for 23 h.In the control group（n=105）,dobutamine was infused for 1 h at an initial dose of 2 μg·kg-1·min-1 without a loading dose,followed by a continuous infusion of 4 μg·kg-1·min-1 for 23 h.Hemodynamic responses at 24 h were evaluated by echocardiography（in both groups） and Swan-Ganz catheter（in the cinepazide group）.Clinical assessment was performed to evaluate efficacy and safety of the medications.Result：The effectiveness rate was 31.67%（38 patients） in the cinepazide group and 18.10%（19 patients） in the control group（P0.01）.At 24 h,left ventricular ejection fraction was improved by 6.4% in the cinepazide group,compared with 4.5% in the control group（P0.05）,stroke volume was increased by 10.6 ml in the cinepazide group and 2.5 ml in the control group（P0.05）.Dyspnea and clinical manifestations improvements were more significant in cinepazide therapy group compared to control group.The plasma brain natriuretic peptide（BNP） levels in treatment group [（1 997±865）pg/ml vs（384±114）pg/ml,P0.01] were significantly higher comparing before and after the treatment,while the control group [（1 879 ± 202） pg / ml vs（1 025 ± 48） pg / ml,P 0.01] were significantly higher comparing before and after the treatment.There were less adverse effects including hypokalemia,hypotension and ventricular premature beats in the cinepazide group than in the dobutamine group（P 0.05）.Conclusion： Cinepazide is well tolerated and superior to dobutamine for patients with decompensated heart

关 键 词：心力衰竭 充血性 桂哌齐特 脑钠肽 疗效 

分 类 号：R541.6[医药卫生—心血管疾病]