左西孟旦治疗心力衰竭晚期患者效果及对相关标志物的影响

摘要

目的 观察左西孟旦应用于心力衰竭晚期的治疗效果及对相关指标的影响.方法 选取2015年3月—2016年3月成都军区总医院收治的晚期心力衰竭患者作为研究对象,随机数字表法分为观察组和对照组各46例.对照组给予常规抗心力衰竭治疗,观察组在对照组治疗基础上加用左西孟旦,初始剂量12μg·kg-1·min-1,静脉推注10min;然后以0.05~0.2μg·kg-1·min-1剂量持续静脉泵入24h.2组患者均连续治疗7d.比较2组患者临床效果,治疗前后心功能指标变化及肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNT)、去甲肾上肾素(NE)、C反应蛋白(CRP)、内皮素(ET-1)水平变化情况;并记录2组患者不良反应发生率及随访1年生存率.结果 观察组总有效率为93.5%,显著高于对照组的78.3%,差异具有统计学意义(χ2=4.389,P=0.036).与治疗前比较,2组治疗后LVEDD、LVEF、SV、CO均改善,且治疗后观察组LVEF、SV、CO明显高于对照组(t=8.489、11.129、6.455,P均=0.000);2组治疗后cTnI、NT-proBNT、NE、ET-1、CRP均改善,且观察组显著低于对照组(t=3.033、3.935、29.157、2.478、3.237,P=0.002、0.000、0.000、0.008、0.001);2组患者治疗过程中发生心动过速、低血压、低血钾、室性早搏、头痛、恶心/呕吐等不良反应发生率比较,差异无统计学意义(P>0.05);随访1年后,观察组病死率明显低于对照组,差异具有统计学意义(8.7%vs.21.7%,χ2=6.556,P=0.010).结论 左西孟旦应用于心力衰竭晚期治疗效果确切,改善心功能作用明显,安全性好,有利于改善患者预后,值得临床推广.%Objective To investigate the effect of levosimendan on advanced heart failure and its effect on related in -dexes.Methods Patients with advanced heart failure were selected, which were treated in hospital from March 2015 to March 2017,and they were divided into the observation group(46 cases)and control group(46 cases).The patients of con-trol group were treated with conventional anti-heart failure treatment.Based on control group,the patients of observation group were treated with levosimendan(initial dose of 12 μg· kg-1· min-1), intravenous injection for 10 min, then intravenous pumped at a dose of 0.05 to 0.2 μg· kg-1· min-1)for 24 h).The patients of 2 groups were all treated for 7 days.Com-pare the clinical outcomes,the incidence of adverse reactions,follow up 1 year survival rate and changes of the levels of heart function,cTnI,NT-proBNP,NE,CRP,ET-1 of two groups.Results After the appropriate treatment,the total effective rate of the observation group was 93.5%, which was significantly higher than 78.3% of the control group(χ2=4.389; P=0.036);The levels of LVEF,SV,CO in the observation group were significantly higher than those in the control group(t=8.489,t=11.129,t=6.455; P=0.000, P=0.000, P=0.000), while the LVEDD level did not change significantly (t=0.615,P=0.269);The levels of cTnI,NT-proBNP,NE,CRP,ET-1 in the observation group were significantly lower than those in the control group(t=3.033, t=3.935, t=29.157, t=2.478, t=3.237; P=0.002, P=0.000, P=0.000,P=0.008,P=0.001);There were tachycardia,hypotension,hypokalemia,ventricular premature beats,headache, nausea /vomiting and other adverse reactions occurred in both two groups,but the difference between groups was not statisti-cally significant(χ2=1.219,χ2=2.222,χ2=0.532,χ2=0.781,χ2=0.274,χ2=3.102; P=0.269, P=0.136, P=0.466,P=0.377,P=0.601,P=0.078);After the follow up for 1 year,the mortality rate in observation group was 8.7%,which was significantly lower than the 21.7%in control group(χ2=6.556; P=0.010).Conclusion Levosimendan in the treatment of advanced heart failure can obtain the exact effect.It has a significant effect on the improvement of heart func-tion and has a high safety,which can improve the prognosis of patients and worthy of clinical promotion.