左西孟旦治疗失代偿性心功能不全的近期效果观察  

Short-term clinical efficacy of levosimendan on treating decompensated cardiac insufficiency

作　　者：张丽媛[1] 贾志[1] 郭牧[1] 张云强[1] 梁海青[1] 田树光 宋昱[1] 

机构地区：[1]天津医科大学心血管病临床学院泰达国际心血管病医院CCU,300457

出　　处：《中国综合临床》2013年第12期1233-1237,共5页Clinical Medicine of China

基　　金：天津市卫生局科技基金资助项目（2011KZ18）;泰达国际心血管病医院课题（TD-2011-07）

摘　　要：目的评价左西孟旦对失代偿性心功能不全患者的近期临床效果。方法120例心力衰竭患者（NYHA心功能Ⅲ、Ⅳ级或KillipⅢ级）随机分为左西孟旦组（60例）和对照组（60例）。左西孟旦组在常规抗心力衰竭药物治疗的基础上加用左西孟旦静脉维持24h。比较治疗前、后的左心室射血分数（LVEF）及B型尿钠肽（BNP）变化，比较两组心功能改善情况及院内病死率，并进行3个月随访。结果治疗后左西孟旦组LVEF较对照组升高[（35．6±13．3）％与（31．4±6．7）％，F=8．952，P=0．003]；治疗后两组BNP均明显降低（P均〈0．05），但左西孟旦组下降更显著[441．0（212．5，1050．0）ng／L与870．0（435．0，1267．0）ng/L，P=0．014]；治疗5d后左西孟旦组心功能变化优于对照组，显效、有效和无效／恶化率分别为45．0％（27／60）、28．3％（17／60）和26．7％（16／60）与20．0％（12／60）、43．3％（26／60）和36．7％（22／60）（OR=2．280，95％CI1．163—4．468，P=0．016）。左西孟旦组与对照组院内及3个月病死率差异均无统计学意义[20％（12／60）与25％（15／60），28．3％（17／60）与41．7％（25／60），x2=1．543，P=0．214；）（2=2．590，P=0．108]，3个月内再住院率左西孟旦组较对照组有降低趋势[21．7％（13／60）与33．3％（20／60），x2=3．591，P=0．058]，而联合终点事件（死亡或再住院）发生率则低于对照组[46．7％（28／60）与66．7％（40／60），x2=4．835，P=0．028]。结论左西孟旦治疗失代偿性心功能不全的近期疗效优于常规治疗。Objective To investigate the short-term clinical efficacy of levosimendan on treating patients with decompensated cardiac insufficiency. Methods One hundred and twenty patients with heart failure （NYHA Ⅲ-Ⅳ or Killip Ⅲ ） were randomly divided into levosimendan group（ n = 60） and control group（ n = 60）. The patients in levosimendan group were given intravenous levosimendan for 24 hours beside conventional heart failure medications. The patients in control group were given the conventional heart failure medications. The left ventricular ejection fraction （LVEF） was recorded and B-type natriuretic peptide （BNP） were measured before and after treatment. NYHA grade and mortality also were recorded. All patients were followed up for 3 months. Results The LVEF in the levosimendan group after the treatment was （ 35.6 ± 13.3 ） %, significantly higher than that in the control group （ （ 31.4 ± 6. 7 ） % , F = 8. 952, P = 0. 002 ）. The BNP in two groups after treatment were lower compared with before treatment（ P 〈 0. 05 ）. And it was more remarkable after treatment in levosimendan group compared with control group （ 441.0 （ 212. 5,1050. 0 ） ng/L vs. 870. 0 （ 435. O, 1267. 0 ） ng/L,P = 0. 014）. The change of NYHA grade in levosimendan group was better than that in control group after 5 d. The recovery rate and ineffective or deterioration rate in levosimendan group were 45.0% （27/60） ,26. 7% （16/30） and 43.3% （ 26/60 ） respectively, higher than that of control group （ 28.3% （ 17/60 ） , 20.00/0 （12/60） ,36.7% （ 22/60 ） ） （ OR = 2. 280,95% C1 1. 163 - 4. 468, P = 0. 016 ） . There was no significant difference in term of mortality between in hospital and 3 months follow-up in the levosimendan and the control group （20% （12/60 ）vs. 25 % （15/60 ）, 28. 3 % （17/30） vs. 41.7 % （25/60）, X2 = 1. 543, P = 0. 214 and X2 = 2. 590 ,P = 0. 108 ）. There was a decreasing trend regarding of readmission rate during 3 months in levosimend

关 键 词：失代偿性心功能不全 左西孟旦 治疗 预后 

分 类 号：R541.6[医药卫生—心血管疾病]