左西孟旦与米力农治疗重症顽固性心衰的疗效及其对血清脑钠肽、尿酸的影响  

Therapeutic effect of levosimendan combined milrinone on severe refractory heart failure and its influence on serum levels of BNP and UA

作　　者：刘崇韬 郑志虹[1] 翁志远[1] LIU Chong-tao;ZHENG Zhi-hong;WENG Zhi-yuan(First Department of Cardiology, Central Hospital of Jiamusi City, Jiamusi, Heilongjiang, 154002, China)

机构地区：[1]黑龙江省佳木斯市中心医院心内一科,黑龙江佳木斯154002

出　　处：《心血管康复医学杂志》2018年第6期658-663,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:研究左西孟旦与米力农治疗重症顽固性心力衰竭(SRHF)的临床疗效及其对血清脑钠肽(BNP)、尿酸(UA)水平的影响。方法:入选我院SRHF患者156例,随机均分为左西孟旦组和米力农组。两组均在常规治疗基础上给予左西孟旦或米力农治疗。持续治疗7d。观察并比较两组治疗前后心率、血压,血清BNP、UA水平,左室收缩末期内径(LVESd)、左室舒张末期内径(LVEDd)、左室射血分数(LVEF)等指标的变化及治疗后总有效率和不良反应发生情况。结果:治疗后与米力农组比较,左西孟旦组心率[(73.79±7.61)次/min比(70.39±7.45)次/min]、收缩压[(128.84±13.11)mmHg比(121.86±12.53)mmHg]、肺部湿啰音得分[(2.05±0.33)分比(1.53±0.21)分]、呼吸困难得分[(2.11±0.36)分比(1.60±0.25)分]、下肢水肿得分[(2.03±0.34)分比(1.50±0.18)分],血清BNP[(459.62±46.27)μg/L比(248.73±25.91)μg/L]、UA[(355.97±36.47)μmol/L比(282.75±28.61)μmol/L]水平均明显降低,LVESd[(41.62±4.52)mm比(36.87±3.71)mm]、LVEDd[(51.89±5.37)mm比(47.85±4.83)mm]明显减小,24h尿量[(3204.59±321.52)ml比(3695.78±370.62)ml]、LVEF[(42.36±4.31)%比(47.85±4.86)%]明显增加(P均<0.01)。左西孟旦组总有效率明显高于米力农组(89.74%比71.79%),不良反应发生率明显低于米力农组(5.13%比28.21%),P均<0.01。结论:左西孟旦治疗重症顽固性心力衰竭可明显降低血清脑钠肽、尿酸水平,改善心功能,疗效显著,安全可靠,较米力农更有优势。Objective:To study therapeutic effect of levosimendan combined milrinone on severe refractory heart failure(SRHF)and its influence on serum levels of brain natriuretic peptide(BNP)and uric acid(UA).Methods:A total of156SRHF patients were enrolled,randomly and equally divided into levosimendan group and milrinone group,both groups received corresponding medication based on routine treatment for7d.Heart rate,blood pressure,serum BNP and UA levels,left ventricular end-systolic dimension(LVESd),left ventricular end-diastolic dimension(LVEDd)and left ventricular ejection fraction(LVEF)before and after treatment,total effective rate and incidence of adverse reactions were observed and compared between two groups.Results:Compared with milrinone group after treatment,there were significant reductions in heart rate[(73.79±7.61)beats/min vs.(70.39±7.45)beats/min],systolic blood pressure[(128.84±13.11)mmHg vs.(121.86±12.53)mmHg],scores of lung wet rales[(2.05±0.33)scores vs.(1.53±0.21)scores],difficulty breathing[(2.11±0.36)scores vs.(1.60±0.25)scores]and lower extremity edema[(2.03±0.34)scores vs.(1.50±0.18)scores],serum levels of BNP[(459.62±46.27)μg/L vs.(248.73±25.91)μg/L]and UA[(355.97±36.47)μmol/L vs.(282.75±28.61)μmol/L],LVESd[(41.62±4.52)mm vs.(36.87±3.71)mm]and LVEDd[(51.89±5.37)mm vs.(47.85±4.83)mm],and significant rise in24h urine volume[(3204.59±321.52)ml vs.(3695.78±370.62)ml]and LVEF[(42.36±4.31)%vs.(47.85±4.86)%]in levosimendan group,P<0.01all.Total effective rate of levosimendan group was significantly higher than that of milrinone group(89.74%vs.71.79%),and incidence rate of adverse reactions was significantly lower than that of milrinone group(5.13%vs.28.21%),P<0.01both.Conclusion:Levosimendan therapy can significantly reduce serum BNP and UA levels,improve cardiac function in SRHF patients.It possesses significant therapeutic effect,and it's safe and reliable,which is better than milrinone.

关 键 词：心力衰竭 利钠肽 脑 左西孟旦 米力农 

分 类 号：R541.61[医药卫生—心血管疾病]