左西孟旦、米力农和多巴酚丁胺治疗急性心力衰竭的对比研究

摘要

目的：观察左西孟旦、米力农和多巴酚丁胺治疗急性心力衰竭(AHF)患者的临床疗效,分析对神经激素因子的影响及安全性。方法90例 AHF患者随机分为米力农组、多巴酚丁胺组和左西孟旦组,观察3组治疗前后临床疗效,左室舒张末内径(LVIDd)、左室射血分数(LVEF)和短轴缩短率(FS)的变化,检测血清血清氨基末端B型利钠肽前体(NT proBNP)、内皮素1(ET 1)、去甲肾上腺素(NE)水平,观察安全性。结果治疗后24 h,左西孟旦组较其他两组总有效率高(P=0.004、0.015),左西孟旦组患者临床状况显著改善。治疗后7 d,3组LVIDd、LVEF及FS均较治疗前改善(P<0.01),左西孟旦组LVIDd与其他两组比较未见缩小(P=0.113),而 LVEF、FS较其他两组增加(P<0.01)。3组治疗后24 h及7 d血清 NT proBNP水平均较基线水平降低(P<0.01),治疗后7 d较治疗后24 h进一步降低(P<0.01)；左西孟旦组治疗后7 d血清 NT proBNP水平比其他两组降低(P=0.006、0.003)。3组治疗后7 d血清ET 1和NE水平较基线水平降低(P<0.01),治疗后7 d左西孟旦组血清NE比其他两组降低更多(P<0.017)。随访3月,左西孟旦组再住院率明显低于其他两组。结论左西孟旦较米力农和多巴酚丁胺能明显改善 AHF患者临床症状,改善心脏收缩功能,降低近期再住院率。%Objective To compare the curative effects of levosimendan,milrinone and dobutamine in treatment of acute heart failure (AHF),and to probe the impacts of heart function,neurohormone factors levels and security.Methods Ninety patients with AHF were randomized into three therapy groups:Milrinone group,dobutamine group and levosimendan group.The clinical effects,left ven-tricular internal diameter at end diastole(LVIDd),left ventricular ejection fraction(LVEF)and fractional shortening(FS)changes,B type natriuretic peptide precursor (NT proBNP),endothelin 1(ET 1),norepinephrine(NE)levels were observed.Results After 24 hours of treatment,total effective rate was higher in levosimendan group than other two groups(P= 0.004,0.015).Levosimen-dan group patients systemic clinical conditions were improved markedly.After 7 days of treatment,LVIDd,LVEF and FS of three groups were better than not treatment(P<0.01).In levosimendan group,LVIDd was not reduced than other groups(P= 0.113), but LVEF and FS were increased(P<0.01).In three groups,serum NT proBNP levels decreased 24 hours and 7 days after treat-ment than baseline(P<0.01),and the level furtherly reduced 7 days after treatment than 24 hours(P<0.01).After 7 days treat-ment,serum NT proBNP of levosimendan group reduced markedly than other groups(P= 0.006,0.003).Serum ET 1 and NE levels of three groups 7 days after treatment reduced than baseline(P<0.01).After 7 days treatment,serum NE of levosimendan group reduced markedly than other groups(P<0.017),In levosimendan group,rehospitalization rate was significantly lower than other groups(P= 0.005,0.013).Conclusion Levosimendan can significantly improve the clinical symptoms in patients with AHF than milrinone and dobutamine,gradual y improve cardiac systolic function,reduce rehospitalization rate.