左西孟旦治疗失代偿性心力衰竭的临床疗效分析  

Clinical efficacy of levosimendan on patients with decompensated heart failure

作　　者：贾志[1] 郭牧[1] 张丽媛[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：《中国实用医刊》2014年第13期1-4,共4页Chinese Journal of Practical Medicine

基　　金：天津市卫生局科技基金（2011KZ18）;泰达国际心血管病医院课题（TD201107）

摘　　要：目的评价左西孟旦治疗失代偿性心力衰竭患者的近期疗效。方法将160例心力衰竭患者随机分为左西孟旦组和对照组，每组80例。左西孟旦组在常规心力衰竭治疗的基础上加用左西孟旦静脉维持24h。比较治疗后两组左心室射血分数（LVEF）及血浆B型尿钠肽（BNP）变化，比较两组住院期间及3个月死亡、再住院及联合终点（死亡或再住院）发生率。结果排除治疗前LVEF的影响，治疗后左西孟旦组LVEF较对照组增加[（31．8±6．1）％与（31．3±5．7）％，P=0．016]。在冠心病亚组中，左西孟旦组LVEF增加优于对照组[（32．6±5．8）％与（32．4±5．3）％，P=0．031]。排除治疗前lg（BNP）的影响，治疗后左西孟旦组lg（BNP）低于对照组[（2．7±0．5）pg／ml与（2．9±0．3）pg／ml，P〈0．01]。治疗后左西孟旦组与对照组院内病死率及3个月内病死率比较差异均无统计学意义（20．0％与23．7％和30．0％与40．0％，P=0．492和P=0．180），而联合终点事件则明显少于对照组（51．2％与70．0％，P=0．031）。在冠心病亚组中，左西孟旦组3个月再住院及联合终点事件发生率均较对照组显著降低（20．4％对37．75和46．9％对73．6％，P=0．014和P=0．010）。结论左西孟旦治疗失代偿性心力衰竭患者的近期疗效优于常规治疗，且对冠心病患者疗效优于非冠心病患者。Objective To evaluate the shor-term efficacy of levosimendan on patients with de- compensated heart failure. Methods One hundred and sixty patients with heart failure were randomly divided into levosimendan group and control group, with 80 cases in each group. Continuous infusion of levosimendan on the basis of conventional therapy was administered for 24 hours in levosimendan group. The left ventrieular ejection fraction （LVEF） and plasma B-type natriuretic peptide （BNP） levels after treatment between the two groups were compared respectively, and the hospital mortality, and 3-month followed-up mortality, readmission or composite outcome （such as death or readmission） were compared. Results After the adjusted effects of LVEF at baseline, the LVEF after treatment in levosimendan group （ n = 70 ） significantly was higher than that in control group （ n = 65 ） [ （ 31.8 ± 6. 1 ） % vs （ 31.3 ± 5.7） %, P =0. 016]. From the primary aetiology stratified, levosimendan was associated with a larger improvement of LVEF in sub-group of coronary heart disease [ （ 32. 6 ± 5.8 ） % vs （ 32.4 ± 5.3 ） % , P = 0. 031 ]. With the adjusted effects of 1 g（BNP） before treatment, the 1 g（BNP） after treatment in levosi- mendan group（ n = 47 ） had a sharper decrease than that in control group （ n = 49 ） [ （2.7 ± 0. 5 ） pg/ml vs （2.9 ±0. 3 ） pg/ml, F = 15.30, P 〈 0.01 ]. Analysis of hospital mortality and followed-up mortality at 3 months showed no difference between the levosimendan group and the control group（20. O%vs 23.7%, 30. 0% vs 40. 0%, P =0. 492 and P =0. 180）, but composite outcome events was lower than the control group（51.2%vs. 70. 0% , P =0. 031 ）. Moreover, levosimendan was associated with a lower incidence rate of readimission and composite outcome events in sub-group of coronary heart disease（20. 4% vs 37. 8% , 46. 9% vs 73.6%, P = 0. 014 and P = 0. 010）. Conclusions Levosimendan is superior to conventional therapy in short-term efficacy for pati

关 键 词：心力衰竭 冠心病 左西孟旦 治疗 预后 

分 类 号：R541.6[医药卫生—心血管疾病]