左西孟旦治疗失代偿心衰合并肾功能不全患者的疗效观察  

Clinical efficacy of levosimendan in patients with decompensated heart failure complicated with renal insufficiency

作　　者：李永梅[1] 梅霞[1] 郑向清[1] 吴非飞[1] 王骄[1] 

机构地区：[1]重庆市中山医院心内科,重庆400013

出　　处：《第三军医大学学报》2016年第8期897-900,共4页Journal of Third Military Medical University

基　　金：重庆市渝中区科技计划项目(20130146)~~

摘　　要：目的观察左西孟旦治疗失代偿心衰合并肾功能不全患者的疗效。方法回顾性分析本科2013年7月至2015年5月住院治疗的63例失代偿心衰患者(男性41例,女性22例),患者按肾功能损害程度分为2组:肾功能重度损害组(L1组)33例[GFR:15~<60 m L/(min·1.73 m^2)]和肾功能轻度损害组(L2组)30例[GFR:60~89 m L/(min·1.73 m^2)],输注左西孟旦治疗。比较、分析治疗后1、3、7、30 d患者N-末端脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-pro-BNP)、左心室射血分数(left ventricular ejection fraction,LVEF)、肾小球滤过率(glomerular filtration rate,GFR)的变化。结果 2组间治疗前除GFR外,其余基线指标差异无统计学意义(P>0.05);2组治疗后NT-pro-BNP 1、3、7 d较基线显著下降(P<0.05),LVEF 3、7 d较基线显著上升(P<0.05);2组间治疗前后NT-proBNP和LVEF差异无统计学意义(P>0.05);2组治疗后GFR 1、3、7 d较基线显著上升(P<0.05),其中L1组GFR 30 d仍较基线显著上升(P<0.05);L1组治疗后GFR改变量(△GFR)显著高于L2组(P<0.05)。结论失代偿心衰合并肾功能不全患者应用左西孟旦,能够改善心肾功能,对肾功能显著下降患者的肾功能改善幅度更大、持续时间更长。Objective To determine the efficacy of levosimendan in patients with decompensated heart failure complicated with renal insufficiency. Methods Clinical data of 63 decompensated heart failure patients hospitalized in the department of cardiology from July 2013 to May 2015 were collected and retrospectively analyzed. These patients were divided into 2 groups according to the renal injury extent： L1 group [glomerular filtration rate（ GFR） ： 15 - 〈60 m L /（ min ·1. 73 m^2）,n = 33]and L2 group [GFR：60 - 89 m L /（ min·1. 73 m^2）,n = 30],and all the patients were treated by infusion of levosimendan. Nterminal pro-B-type natriuretic peptide（ NT-pro-BNP）,left ventricular ejection fraction（ LVEF）,and GFR were compared and analyzed before treatment and on 1,3,7,and 30 d after treatment. Results Before treatment,there were no significant differences in the baseline data between the 2 groups except GFR（ P〉0. 05）. On 1,3 and 7 d after treatment,NT-pro-BNP were significantly decreased in the 2 groups（ P〈0. 05）,and on 3 and 7 d after treatment,LVEF was significantly higher than the baseline value. Before and after treatment,NT-pro-BNP and LVEF showed no significant differences between the 2 groups（ P〉0. 05）.On 1,3 and 7 d after treatment,GFR was significantly increased in the 2 groups（ P〈0. 05）,and on 30 d after treatment,GFR of group L1 was still increased（ P〈0. 05）. After treatment,the level of △GFR（ GFR change） was significantly higher in the L1 group than in the L2 group. Conclusion Levosimendan can improve heart and kidney functions in the patients with decompensated heart failure complicated with renal insufficiency,and the improvement of renal function is greater and longer in the patients with severe renal insufficiency.

关 键 词：左西孟旦 心力衰竭 肾功能不全 肾小球滤过率 

分 类 号：R541.61[医药卫生—心血管疾病] R692.05[医药卫生—内科学]