盐酸多巴酚丁胺或左西孟旦治疗急性心力衰竭的临床效果及对血清脑利钠肽、尿酸的影响观察  

Curative Effect of Dobutamine Hydrochloride or Levosimendan on Acute Heart Failure and Their Influences on Serum Brain Natriuretic Peptide and Uric Acid

作　　者：朱洪新 王皓 霍建凤 王涛[1] ZHU Hong-xin;WANG Hao;HUO Jian-feng;WANG Tao(Department of Cardiology,the Second Hospital of Qinhuangdao,Qinhuangdao,Hebei 066600,China;Department of Respiratory Medicine,the Second Hospital of Qinhuangdao,Qinhuangdao,Hebei 066600,China)

机构地区：[1]秦皇岛市第二医院心内科,河北秦皇岛066600 [2]秦皇岛市第二医院呼吸科,河北秦皇岛066600

出　　处：《临床误诊误治》2020年第9期24-28,共5页Clinical Misdiagnosis & Mistherapy

基　　金：秦皇岛市科学技术研究与发展计划(201805A121)。

摘　　要：目的探讨盐酸多巴酚丁胺或左西孟旦治疗急性心力衰竭(acute heart failure,AHF)的临床效果及对血清脑利钠肽(brain natriuretic peptide,BNP)、尿酸的影响。方法选取2017年5月—2019年5月收治的78例AHF作为研究对象,根据治疗方法的不同,分为盐酸多巴酚丁胺组和左西孟旦组,每组各39例。盐酸多巴酚丁胺组予盐酸多巴酚丁胺治疗,左西孟旦组予左西孟旦治疗。两组均治疗7 d。观察治疗后临床效果,检测治疗前后心功能相关指标[左心室射血分数(left ventricular ejection fraction,LVEF)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)及每搏输出量(stroke volume,SV)]、BNP、血清炎性因子相关指标[白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]、尿酸及血清K+、Na+水平变化,记录治疗期间不良反应发生情况。结果与盐酸多巴酚丁胺组比较,左西孟旦组治疗后总有效率升高,差异有统计学意义(P<0.05)。与盐酸多巴酚丁胺组治疗后比较,左西孟旦组治疗后LVEF、SV水平升高,血清BNP、IL-6、TNF-α、尿酸水平下降,差异有统计学意义(P<0.05或P<0.01);与本组治疗前比较,两组治疗后LVEF、SV水平升高,LVESV、LVEDV水平降低,血清BNP、IL-6、TNF-α、尿酸水平下降,差异有统计学意义(P<0.05或P<0.01)。治疗期间,两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论左西孟旦较盐酸多巴酚丁胺治疗AHF的临床效果好,有利于降低BNP及尿酸水平,且安全性较高。Objective To investigate the curative effect of Dobutamine Hydrochloride or Levosimendan on acute heart failure(AHF)and their influences on serum brain natriuretic peptide(BNP)and uric acid(UA).Methods Seventy-eight AHF patients who were admitted from May 2017 and May 2019 were selected as research subjects.They were divided into Dobutamine Hydrochloride group and Levosimendan group according to different treatment methods,with 39 cases in each group.Dobutamine Hydrochloride group was given Dobutamine Hydrochloride,while Levosimendan group was given Levosimendan.All patients were continuously treated for 7 d.The clinical effect was observed,and cardiac function-related indexes[left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),stroke volume(SV)],BNP and levels of inflammatory factors[(interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],UA,K+and Na+concentrations were observed.The occurrence of adverse reactions during treatment was recorded.Results After treatment,the total effective rate in Levosimendan group was significantly higher than that in Dobutamine Hydrochloride group(P<0.05).After treatment,the LVEF and SV levels in the Levosimendan group was significantly higher than that of the Dobutamine Hydrochloride group,while the levels of BNP,IL-6,TNF-αand UA were significantly lower than those of the Dobutamine Hydrochloride group(P<0.05 or P<0.01).Compared with those in the same group before treatment,LVEF and SV levels were increased,while LVESV and LVEDV levels,serum BNP,IL-6,TNF-α,and UA levels were decreased after treatment in the two groups.There were significant differences(P<0.05 or P<0.01).There was no difference in the incidence of adverse reactions during treatment between the two groups(P>0.05).Conclusion The curative effect of Levosimendan on AHF is better than that of Dobutamine Hydrochloride,which is more conductive to reduce levels of BNP and UA,with relatively higher safety.

关 键 词：心力衰竭 急性 左西孟旦 多巴酚丁胺 利钠肽 脑 尿酸 左心室射血分数 白细胞介素-6 肿瘤坏死因子-α 

分 类 号：R541.6[医药卫生—心血管疾病]