左西孟旦治疗急性心衰临床应用专家共识  

Expert Consensus on Clinical Application of Levosimendan in the Treatment of Acute Heart Failure

作　　者：王琳娜[1] 王晶[4] 徐艳丽[1] 周晗慈 潘文静[5] 王迪[3] 公永太[5] 刘玉强 金恩泽[3] 中国中医药信息学会睡眠分会 黑龙江省医师协会心血管内科专业委员会 黑龙江省医学会心血管内科专业委员会 WANG Linna;WANG Jing;XU Yanli;ZHOU Hanci;PAN Wenjing;WANG Di;GONG Yongtai;LIU Yuqiang;JIN Enze;Sleep Branch of China Information Association of Traditional Chinese Medicine;Professional Committee of Cardiovascular Medicine of Heilongjiang Medical Doctor Association;Professional Committee of Cardiovascular Medicine of Heilongjiang Medical Association(Department of Pharmacy,the Fourth Affiliated Hospital of Harbin Medical University,Heilongjiang Harbin 150001,China;Department of Emergency,the Fourth Affiliated Hospital of Harbin Medical University,Heilongjiang Harbin 150001,China;Department of Cardiologyc,the Fourth Affiliated Hospital of Harbin Medical University,Heilongjiang Harbin 150001,China;Department of Neurology,the First Affiliated Hospital of Harbin Medical University,Heilongjiang Harbin 150001,China;Department of Cardiology,the First Affiliated Hospital of Harbin Medical University,Heilongjiang Harbin 150001,China;Department of Pharmacy,Changzhi People's Hospital,Shanxi Changzhi 046000,China;不详)

机构地区：[1]哈尔滨医科大学附属第四医院药学部,黑龙江哈尔滨150001 [2]哈尔滨医科大学附属第四医院急诊科,黑龙江哈尔滨150001 [3]哈尔滨医科大学附属第四医院心内科,黑龙江哈尔滨150001 [4]哈尔滨医科大学附属第一医院神经内科,黑龙江哈尔滨150001 [5]哈尔滨医科大学附属第一医院心内科,黑龙江哈尔滨150001 [6]长治市人民医院药学部,山西长治046000 [7]不详

出　　处：《中国医药导刊》2025年第1期87-93,共7页Chinese Journal of Medicinal Guide

基　　金：北京协和医学基金会一睿E急诊医学研究基金资助项目(PUMF01010010-2024-15);哈尔滨医科大学附属第四医院优秀青年项目(HYDSYYXQN2023012)。

摘　　要：急性心力衰竭(AHF)属急诊科常见急危重症之一,病情复杂多变,治疗难度高,患者通常预后不佳,具有较高致残或致死率,需紧急进行救治。临床治疗AHF的首要手段为药物治疗。正性肌力药在AHF治疗中具有不可替代的作用。左西孟旦作为新型正性肌力药,不仅具有正性肌力作用,还具有恢复脑室-动脉耦合、增加组织灌注、抗炎等作用,可有效弥补传统正性肌力药为发挥正性肌力作用增加心肌氧耗的不足。随着左西孟旦研究的不断深入,其临床适应证逐步拓宽,在重度心力衰竭乃至AHF相关合并症治疗中亦可提供潜在益处。为更好地规范和指导左西孟旦在AHF临床实践中的应用,本研究结合我国现有实践及经验,共同制定“左西孟旦治疗急性心衰临床应用专家共识”,建议左西孟旦在AHF中应规范应用,包括①左西孟旦适应证可拓宽至晚期心衰患者,但仍需临床医师严格根据患者实际个体化用药。②左西孟旦在AHF合并症患者中治疗的有效性及安全性尚缺乏可靠循证研究,仍属超指征用药,需临床医师根据患者实际谨慎选择。③左西孟旦在AHF治疗中具有显著优势,主要体现在不影响细胞内Ca^(2+)浓度、不影响心脏舒张功能、不激活交感神经系统、不增加心肌耗氧量、缓解心脏负担、增强心搏出量、抵抗心肌缺血损伤、改善组织灌注及恢复脑室动脉耦合等。④左西孟旦治疗AHF过程中出现的不良反应较多,在临床使用时应了解左西孟旦使用注意事项,及时观察药品不良反应,以便及时处理,避免严重的不良事件的发生。Acute heart failure(AHF)is one of the common acute and critical diseases in the emergency department.The condition is complex and changeable,and the treatment is difficult.The patients usually have poor prognosis,high disability or fatality rate,and need urgent treatment.Clinical treatment of AHF,the primary means is drug therapy.Positive inotropic drugs play an irreplaceable role in the treatment of AHF.As a new positive inotropic drug,levosimendan not only has positive inotropic effect,but also has the effects of restoring ventriculoarterial coupling,increasing tissue perfusion,anti-inflammatory,etc.,which can effectively make up for the defi-ciency of traditional positive inotropic drugs in increasing myocardial oxygen consumption to exert positive inotropic effect.With the deep-ening of research on levosimendan,its clinical indications are gradually broadened,and it can also provide potential benefits in the treat-ment of severe heart failure and even AHF-related comorbidities.In order to better standardize and guide the application of levosimendan in the clinical practice of AHF,the consensus expert group combined with China's existing practice and experience to jointly develop the"Expert Consensus on Clinical Application of Levosimendan in the Treatment of Acute Heart Failure",suggesting that levosimendan should be standardized in AHF.①The indications of leveosemendan can be expanded to patients with advanced heart failure,but clini-cians still need to strictly individualize medication according to the actual situation of patients.②The efficacy and safety of levosimendan in the treatment of patients with AHF complications are still lacking reliable evidence-based studies,and it is still an extra-prescriptive drug,which should be carefully selected by clinicians according to the actual situation of patients.③Levosimendan has significant advan-tages in the treatment of AHF,which are mainly reflected in that it does not affect the intracellular Ca^(2+)concentration,does not affect the diastolic function

关 键 词：急性心力衰竭 左西孟旦 正性肌力药物 临床应用 专家共识 

分 类 号：R541.6[医药卫生—心血管疾病]