不同剂量左西孟旦对慢性心力衰竭患者影响的对比研究

摘要

目的 比较不同剂量左西孟旦对慢性心力衰竭(CHF)患者的影响.方法 选取2014年1月-2017年1月同济大学附属第十人民医院收治的CHF患者100例,采用抽签法分为A组、B组、C组、D组,每组25例.在常规治疗基础上,A组患者给予米力农(负荷剂量50 μg/kg,维持剂量0.5 μg·kg-1·min-1)治疗,B组、C组、D组患者均给予左西孟旦,负荷剂量均为12 μg/kg,维持剂量分别为0.1 μg·kg-1·min-1、0.2 μg·kg-1·min-1、0.3 μg·kg-1·min-1;4组患者均连续治疗1周.比较4组患者治疗前1 h、治疗24 h、治疗72 h、治疗结束时改良版英国医学研究会呼吸困难量表(mMRC)评分及心率(HR),治疗前1 h及治疗结束时心功能指标〔包括左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、每搏输出量(SV)〕,记录4组患者治疗期间不良反应发生情况.结果 时间与方法在mMRC评分、HR上存在交互作用(P<0.05);时间在mMRC评分、HR上主效应显著(P<0.05);方法在mMRC评分、HR上主效应显著(P<0.05);治疗24、72 h及治疗结束时B、C、D组患者mMRC评分低于A组,治疗24 h C、D组患者mMRC评分低于B组,治疗72 h D组患者mMRC评分低于B组(P<0.05);治疗24 h D组患者HR高于A组,治疗72 h、治疗结束时D组患者HR高于A、B、C组(P<0.05).4组患者治疗前1 h LVEDD、LVEF、SV及治疗结束时LVEDD比较,差异无统计学意义(P>0.05);治疗结束时B、C、D组患者LVEF、SV高于A组(P<0.05).D组患者治疗期间不良反应发生率高于A、B组(P<0.05).结论 与米力农相比,左西孟旦可更有效地改善CHF患者呼吸困难症状及心功能,且大剂量左西孟旦的改善作用优于小剂量左西孟旦,但大剂量左孟西旦所致心律失常及不良反应发生风险升高,临床应根据患者个体情况及耐受性等选择应用.%Objective To compare the impact on patients with chronic heart failure in different doses of levosimendan.Methods A total of 100 patients with chronic heart failure were selected in the Tenth People′s Hospital Affiliated to Tongji University from January 2014 to January 2017,and they were divided into A group,B group,C group and D group according to envelope method,each of 25 cases.Based on conventional treatment,patients of A group received milrinone(load-dose was 50 μg/kg,maintenance dose was 0.5μg·kg-1·min-1),patients of B group,C group and D group received levosimendan(load-dose was 12 μg/kg,maintenance dose was 0.1 μg·kg-1·min-1,0.2 μg·kg-1·min-1 and 0.3 μg·kg-1·min-1,respectively);all of the four groups continuously treated for 1 weeks.British Medical Research Council Dyspnea Scale(mMRC)score and heart rate before 1 hour of treatment,after 24 hours and 72 hours of treatment,and at the end of treatment,index of cardiac function(including LVEDD,LVEF and SV)before 1 hour of treatment and at the end of treatment were compared among the four groups,and incidence of adverse reactions was recorded during the treatment.Results There was interaction between time and method in mMRC score and heart rate(P<0.05);main effects of time and method were significant in mMRC score and heart rate(P<0.05);after 24 hours and 72 hours of treatment,and at the end of treatment,mMRC score of B group,C group and D group was statistically significantly lower than that of A group,respectively(P<0.05);after 24 hours of treatment,mMRC score of C group and D group was statistically significantly lower than that of A group,B group,respectively(P<0.05);after 72 hours of treatment,mMRC score of D group was statistically significantly lower than that of B group(P<0.05);after 24 hours of treatment,heart rate of D group was statistically significantly higher than that of A group(P<0.05);after 72 hours of treatment and at the end of treatment,heart rate of D group was statistically significantly higher than that of A group,B group and C group,respectively(P<0.05).No statistically significant differences of LVEDD,LVEF or SV was found among the four groups before 1 hour of treatment,nor was LVEDD was found among the four groups at the end of treatment(P>0.05),while LVEF and SV of B group,C group and D group were statistically significantly higher than those of A group(P<0.05).Incidence of adverse reactions of D group was statistically significantly higher than that of A group and B group,respectively(P<0.05).Conclusion Compared with milrinone,levosimendan can more effectively relieve the dyspnea symptom and improve the cardiac function,and high-dose levosimendan has preferable improvement effect than low-dose levosimendan,but risk of arrhythmia and adverse reactions caused by high-dose levosimendan significantly increases,we should choose reasonable dose of levosimendan according to the patient′s individual situation and tolerability on clinic.