左西孟旦与米力农治疗心力衰竭的疗效比较  

Efficacy of levosimendan vs.milrinone in decompensated heart failure patients

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,天津300457

出　　处：《中华急诊医学杂志》2014年第7期740-745,共6页Chinese Journal of Emergency 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（TD-2011-07）

摘　　要：目的 探讨常规治疗基础上分别联用左西孟旦和米力农治疗失代偿心力衰竭的近期临床疗效及安全性.方法 180例心力衰竭患者（NYHA心功能Ⅲ～Ⅳ级）随机（随机数字法）分为对照组、米力农组和左西孟旦组各60例.米力农组在常规心衰药物治疗基础上加用米力农静脉维持72 h,左西孟旦组加用左西孟旦静脉维持24 h.比较治疗前、后的左心室射血分数（LVEF）、左室舒张末期内径（LVDD）及B型利钠肽（BNP）变化,比较3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高于对照组[（32.0±6.3）％vs.（30.6±5.5）％,P =0.007].与治疗前比较,治疗后对照组、米力农组和左西孟旦组BNP质量浓度分别降低444.0（-74.0,1068.0） pg/mL、469.0 （141.5,1151.5） pg/mL和936.5（437.8,1566.8）pg/mL （P ＜0.01）;与对照组和米力农组比较,左西孟旦组BNP下降更为显著（t=3.256,P=0.004和t=2.665,P=0.026）.治疗5d后左西孟旦组心功能好转至少达到有效的可能性是对照组的2.036倍（95％CI：1.030～4.028,P=0.041）.3组院内及3个月病死率、再住院率差异均无统计学意义（P＞0.05）,但3个月联合终点事件发生率左西孟旦组较米力农组显著降低（50.0％vs.70.0％,HR=0.573,95％ CI：0.358 ～0.917,P=0.020）.结论 左西孟旦治疗失代偿性心力衰竭的近期疗效优于米力农和常规治疗.Objective To evaluate the short-term clinical efficacy and safety of administration of levosimendan or milrinone added to conventional therapy in patients with decompensated heart failure.Methods A total of 180 patients admitted due to heart failure [NYHA （New York Heart Association） class Ⅲ or Ⅳ] were randomly （random number） divided into control group,milrinone group and levosimendan group （n =60,each group）.A continuous infusion of milrinone added to conventional therapy was administered for 72 hours in milrinone group,while administration of levosimendan for 24 hours in levosimendan group.The changes in left ventricular ejection fraction （LVEF）,left ventricle end-diastolic diameter （LVDD） and B-type natriuretic peptide （BNP） plasma level were compared between before and after treatment,respectively,and comparisons of improvement in cardiac function （NYHA class） and hospital mortality were carried out among three groups.Patients were further followed up at 3 months after treatment.Results The LVEF in levosimendan group after treatment had significantly more increased than that in control group [（32.0±6.3）% vs.（30.6 ±5.5）%,P =0.007].Compared BNP before treatment,the sums of BNP deducted were 444.0 （-74.0,1068.0） pg/mL,469.0 （141.5,1151.5） pg/mL and 936.5 （437.8,1566.8） pg/mL in control group,milrinone group and levosimendan group,respectively after treatment （all P 〈 0.01）.Moreover,the deduction in BNP was more dramatic in levosimendan group compared with control or milrinone group （t =3.256 or 2.665,P =0.004 or 0.026）.After treatment for 5 days,the probability at least of achieving more effectively better improvement in NYHA class （cardiac function） in levosimendan group was 2.036 times that of control group （95% CI：1.030-4.028,P =0.041）.The incidence of combined end point events （death or readmission） in levosimendan group was significantly lower than that in milrinone group （50% vs.70%,HR =0.573,95% CI：0.358-0.917,P=0.020）,wh

关 键 词：心力衰竭 左西孟旦 米力农 治疗 预后 

分 类 号：R541.6[医药卫生—心血管疾病]