不同剂量左西孟旦治疗老年重症心力衰竭的临床研究

Effects of different doses of levosimendan on cardiac function and prognosis in elderly patients with severe heart failure

摘要:

目的 分析不同剂量左西孟旦对老年重症心力衰竭患者心功能及预后的影响。方法 选取2016年5月—2019年6月金华市中心医院收治的老年重症心力衰竭患者150例。按照随机数字表法分为A、B、C组，每组50例。患者均给予常规治疗，伴有高血压、糖尿病等基础病患者给予降压、降糖药控制血压血糖，二尖瓣狭窄者需要进行球囊扩张、外科换瓣等治疗。在此基础上，A、B、C组分别给予剂量为0.2 μg/（kg·min）、0.3 μg/（kg·min）、0.4 μg/（kg·min）的左西孟旦治疗。比较3组心功能［左心室射血分数（LVEF）、每搏输出量（SV）、心肌做功指数（MPI）］、心衰标志物［氨基末端B型脑钠肽前体（NT-proBNP）］、心肌细胞［可溶性细胞凋亡因子（sFas）、sFas配体（sFasL）］、血流动力学［心率（HR）、平均动脉压（MAP）、心脏指数（CI）］、不良反应、1年存活率。结果 各组患者治疗前LVEF、SV、MPI比较，差异无统计学意义（P >0.05）。C组治疗后LVEF、SV较A组和B组增加（P <0.05），MPI较A组和B组低（P <0.05）。各组患者治疗前NT-proBNP、sFas、sFasL水平比较，差异无统计学意义（P >0.05）。C组治疗后NT-proBNP、sFas、sFasL水平较A组和B组低（P <0.05）。各组患者治疗前MAP、CI、HR比较，差异无统计学意义（P >0.05）。C组治疗后MAP、CI较A组和B组高（P <0.05），HR较A组和B组低（P <0.05）。各组患者不良反应率比较，差异无统计学意义（P >0.05）。各组患者1年生存率比较，差异无统计学意义（P >0.05）。结论 0.4 μg/（kg·min）剂量左西孟旦治疗老年重症心力衰竭患者疗效最佳，可有效改善心功能及血流动力学，降低心力衰竭严重程度，减少心肌细胞凋亡，预后较好，且未明显增加不良反应。

Abstract:

Objective To analyze the effects of different doses of levosimendan on cardiac function and prognosis in elderly patients with severe heart failure.Methods A total of 150 elderly patients with severe heart failure who were admitted to Jinhua Municipal Central Hospital from May 2016 to June 2019 were randomly divided into three groups, with 50 cases in each group. All patients were given conventional treatment, and patients with underlying diseases such as hypertension and diabetes were given antihypertensive and hypoglycemic drugs to control blood pressure and blood sugar, while those with mitral valve stenosis were treated with balloon dilation and surgical valve replacement. On the basis of these treatments, group A, B, and C were administrated 0.2 μg/(kg·min), 0.3 μg/(kg·min), and 0.4 μg/(kg·min) of levosimendan, respectively. The cardiac function [left ventricular ejection fraction (LVEF), stroke volume (SV), and myocardial performance index (MPI)], heart failure marker [N-terminal pro-B-type natriuretic peptide (NT-proBNP)], apoptosis of myocardial cells [soluble Fas (sFas) and sFas ligand (sFasL)], hemodynamics [heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI)], adverse reactions, 1-year survival rate and other indicators were compared among the groups.Results There was no difference in LVEF, SV, MPI, NT-proBNP, sFas, sFasL, MAP, CI, and HR before the treatment among the groups (P > 0.05). After 4 weeks of treatment, group C showed higher LVEF and SV but lower MPI than group A and B (P < 0.05). The levels of NT-proBNP, sFas, and sFasL were lower in group C compared with group A and B (P < 0.05). Besides, MAP and CI were higher but HR was lower in group C than in group A and B (P < 0.05). However, no difference was observed in adverse reactions or 1-year survival rate among the groups (P > 0.05).Conclusions Levosimendan at the dose of 0.4 μg/(kg·min) is optimal in the treatment of elderly patients with severe heart failure. It can effectively improve the heart function and hemodynamics, reduce the severity of heart failure, and ameliorate the apoptosis of myocardial cells, with a better prognosis and no significant increase in adverse reactions.