左西孟旦治疗肺动脉高压合并右心衰竭患者疗效分析——Meta分析  

Efficacy of levosimendan in the treatment of pulmonary hypertension combined with right heart failure:a meta-analysis

作　　者：吴义刚 潘裕民 吴姗姗 胡梦涓 王一为 张劲松 乔莉 Yigang Wu;Yumin Pan;Shanshan Wu;Mengjuan Hu;Yiwei Wang;Jinsong Zhang;Li Qiao(Department of Emergency and Critical Care Medicine,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Kangda College of Nanjing Medical University,Lianyungang 222000,China;Department of Quality Management,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Hainan Tibetan Autonomous Prefecture People's Hospital of Qinghai Province,Hainan 813099,China)

机构地区：[1]南京医科大学第一附属医院急诊与危重症医学科,南京210029 [2]南京医科大学康达学院,连云港222000 [3]南京医科大学第一附属医院质量管理处,南京210029 [4]青海省海南藏族自治州人民医院,海南813099

出　　处：《中华危重症医学杂志(电子版)》2024年第5期385-391,共7页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：江苏省医院管理创新研究基金资助项目(JSYGY-3-2023-554)。

摘　　要：目的评价左西孟旦治疗肺动脉高压(PH)合并右心衰竭患者的临床疗效。方法检索PubMed、Embase、Web of Science、Cochrane Library、万方数据库、维普中文数据库、中国知网,纳入左西孟旦治疗PH合并右心衰竭患者疗效的相关文献,检索时限为建库至2022年11月30日,采用Jüni量表对纳入文献进行质量评价,数据分析采用Review Manager 5.4软件进行。结果共纳入10项研究,包含681例PH合并右心衰竭患者。Meta分析结果显示经左西孟旦治疗后,肺动脉平均压[标准化均数差(SMD)=-1.35,95%置信区间(CI)(-2.55,-0.15),Z=2.20,P=0.03]、肺动脉收缩压[SMD=-0.82,95%CI(-1.09,-0.55),Z=5.93,P<0.00001]以及N末端脑钠肽前体[SMD=-0.80,95%CI(-1.17,-0.42),Z=4.12,P<0.0001]均明显降低,三尖瓣环收缩期位移[SMD=0.49,95%CI(0.29,0.68),Z=4.88,P<0.00001]、混合静脉血氧饱和度[SMD=0.60,95%CI(0.32,0.89),Z=4.12,P<0.0001]以及六分钟步行距离[SMD=0.62,95%CI(0.40,0.84),Z=5.52,P<0.00001]均明显升高。结论左西孟旦可以显著降低PH合并右心衰竭患者的肺动脉压力,改善右心室功能,提高运动耐力,对PH合并右心衰竭患者产生有利影响。Objective To evaluate the efficacy of levosimendan in the treatment of pulmonary hypertension(PH)combined with right heart failure.Methods PubMed,Embase,Web of Science,Cochrane Library,Wanfang,VIP and CNKI databases were searched for studies on the efficacy of levosimendan in the treatment of patients with right heart failure and PH published up to November 30,2022.The Jüni scale was used to evaluate the quality of the included literature.The Review Manager 5.4 software was used for data analysis.Results A total of 10 studies were included,containing 681 patients with PH and right heart failure.The meta-analysis showed that after levosimendan treatment,their mean pulmonary artery pressure[standard mean difference(SMD)=-1.35,95%confidence internal(CI)(-2.55,-0.15),Z=2.20,P=0.03],systolic pulmonary artery pressure[SMD=-0.82,95%CI(-1.09,-0.55),Z=5.93,P<0.00001]and N-terminal pro-brain natriuretic peptide[SMD=-0.80,95%CI(-1.17,-0.42),Z=4.12,P<0.0001]were significantly decreased,while their tricuspid annular plane systolic excursion[SMD=0.49,95%CI(0.29,0.68),Z=4.88,P<0.00001],mixed venous oxygen saturation[SMD=0.60,95%CI(0.32,0.89),Z=4.12,P<0.0001]and 6-minute walking distance[SMD=0.62,95%CI(0.40,0.84),Z=5.52,P<0.00001]were significantly increased.Conclusion Levosimendan can significantly reduce pulmonary artery pressure,improve right ventricular function and increase exercise tolerance in patients with PH and right heart failure.

关 键 词：左西孟旦 肺动脉高压 右心衰竭 META分析 

分 类 号：R54[医药卫生—心血管疾病]