基于DID模型的左西孟旦联合多巴胺对急性心力衰竭患者心功能和肾功能影响的动态分析  

Dynamic Analysis on Effects of Levosimendan Combined with Dopamine on Cardiac and Renal Function in Patients with Acute Heart Failure Based on DID Model

作　　者：吴申 张鑫 谷阳[1] WU Shen;ZHANG Xin;GU Yang(Dept.of Cardiovascular Medicine,Huai’an First People’s Hospital/the Affiliated Huai’an No.1 Hospital of Nanjing Medical University,Jiangsu Huai’an 223300,China)

机构地区：[1]淮安市第一人民医院/南京医科大学附属淮安第一医院心血管内科,江苏淮安223300

出　　处：《中国医院用药评价与分析》2022年第11期1334-1339,共6页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：中华国际医学交流基金会心血管多学科整合思维研究基金项目(No.z-2016-23-2101-46)。

摘　　要：目的:基于双重差分法(DID)模型动态分析左西孟旦联合多巴胺对急性心力衰竭患者肾功能的影响。方法:将2019年1月至2021年1月于该院就诊的急性心力衰竭患者225例,采用随机数字表法分为研究组(n=112例)及对照组(n=113例)。对照组患者给予常规心力衰竭治疗及多巴胺静脉泵入[1~5μg/(kg·min)];研究组患者在对照组的基础上给予左西孟旦,起始负荷剂量(12μg/kg)静脉注射10 min,后以0.1μg/(kg·min)的速度静脉滴注以强心治疗。比较两组患者治疗前后的肾功能及心功能指标,采用DID法对左西孟旦的临床疗效进行评价,并使用Stata软件中Coefplot包绘制平行趋势检验图形。结果:治疗1、2、3及4周后,两组患者的左心室射血分数(LVEF)、每搏输出量(SV)、心脏指数(CI)和肾小球滤过率(GFR)较治疗前明显升高,血尿素氮(BUN)、血清肌酐(SCr)和N-末端B型利钠肽原(NT-proBNP)水平均较治疗前明显降低;治疗1、2及3周后,研究组患者LVEF、SV、CI和GFR水平明显高于对照组,BUN、SCr和NT-proBNP水平明显低于对照组,差异均有统计学意义(P<0.05);而治疗4周后,两组患者上述指标水平的差异均无统计学意义(P>0.05)。DID效应分析结果显示,治疗方案与急性心力衰竭患者心、肾功能改善显著相关(P均<0.05)。结论:左西孟旦联合多巴胺能改善急性心力衰竭患者早期肾功能,提高患者心功能及左心室活动能力。OBJECTIVE:To dynamically analyze the effects of leosimendan combined with dopamine on renal function in patients with acute heart failure based on DID model.METHODS:A total of 225 patients with acute heart failure admitted to this hospital from Jan.2019 to Jan.2021 were divided into research group(112 cases)and control group(113 cases)via the random number table.The control group was given conventional therapy for cardiac failure combined with dopamine for intravenous pump[from 1 to 5μg/(kg·min)];while the research group was given leosimendan based on the control group,with the initial loading dosage(12μg/kg)administrated intravenously for 10 min,followed by intravenous drip at the velocity of 0.1μg/(kg·min)for cardiac tonic treatment.Indicators of renal function and cardiac function were compared between two groups before and after treatment,the clinical efficacy of levosimendan was evaluated by using the DID method,and the parallel trend test graphs were plotted by using the Coefplot package in Stata software.RESULTS:After 1,2,3 and 4 weeks of treatment,the left ventricular ejection fraction(LVEF),stroke volume(SV),cardiac index(CI)and glomerular filtration rate(GFR)of both groups were significantly higher than those before treatment,the blood urea nitrogen(BUN),serum creatinine(SCr)and N-terminal B-type natriuretic peptidogen(NT-proBNP)levels of both groups were significantly lower than those before treatment;after 1,2 and 3 weeks of treatment,the LVEF,SV,CI and GFR levels of the research group were significantly higher than those of the control group,the BUN,SCr and NT-proBNP levels of research group were significantly lower than those of the control group,with statistically significant differences(P<0.05);after 4 weeks of treatment,there were no significant difference in the above indexes between the two groups(P>0.05).The results of DID effect analysis showed that there was a statistically significant improvement in cardiac and renal function between the treatment regimen and the AHF patients(P<0.05).C

关 键 词：左西孟旦 多巴胺 急性心力衰竭 肾功能 双重差分法 

分 类 号：R972[医药卫生—药品]