钙离子增敏剂治疗慢性心力衰竭失代偿患者的临床疗效和安全性观察

doi:10.3969/j.issn.1006-6233.2018.10.019

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摘要 目的: 探讨钙离子增敏剂(左西孟旦)治疗慢性心力衰竭失代偿患者的临床疗效和安全性。方法: 选取2016年10月到2017年10月在我院住院的慢性心力衰竭失代偿NYHA心功能分级Ⅲ~Ⅳ级住院患者97例,随机分为常规治疗组45例和左西孟旦组52例,常规治疗组采用心力衰竭标准化药物治疗(包括利尿剂、醛固酮受体拮抗剂、洋地黄类、ACEI/ARB、β受体阻滞剂等);左西孟旦组是在常规治疗的基础上加用左西孟旦静脉泵入;两组患者均在入院24h以及治疗第7d分别测量左室射血分数(LVEF),抽取清晨血浆测定NT-proBNP、生化指标(肌酐、ALT、AST),计算肾小球滤过率(eGFR),评定两组治疗前后的NYHA心功能分级。结果:治疗第7天,常规治疗组与左西孟旦组治疗前后自身对照,其LVEF、NT-proBNP、尿量、NYHA心功能分级均较治疗前有所改善,差异有统计学意义(P<0.05);组间比较左西孟旦组较常规治疗组LVEF提高、NT-proBNP降低、尿量增加,NYHA心功能分级提高的更显著,差异有统计学意义(P<0.05);两组治疗前后的肝肾功能,肾小球滤过率无显著性差异(P>0.05)。结论:早期应用左西孟旦治疗慢性心力衰竭失代偿患者,能明显提高LVEF,降低NT-proBNP、同时能增加患者的尿量,改善NYHA心功能的分级,有较好的临床效果,同时不损伤肝肾功能,安全性好。

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关键词 ：钙离子增敏剂, 慢性心力衰竭失代偿, 左心室射血分数, 肾小球滤过率, NT-proBNP

Abstract：Objective: To investigate the efficacy and safety of calcium sensitizer(levosimendan)in treatment of chronic decompensated congestive heart failure. Methods: 97 patients with decompensated NYHA grade III to IV heart function were enrolled in our hospital from October 2016 to October 2017. All the patients were randomly divided into comentional treatment group (45 cases) and levosimendan group (52 cases). The comentional treatment group was treated with standardized drugs (including diuretics, aldosterone receptor antagonists, digitalis, ACEI/ARB, beta blockers, etc.). Levosimendan group was treated with levosimendan pump on the basis of comentional treatment. Left ventricular ejection fraction (LVEF) was measured 24 hours after admission and 7 days after treatment. NT-proBNP and biochemical indexes (creatinine, ALT, AST) were measured in the morning plasma and glomerular filtration rate (eGFR) was calculated. The NYHA cardiac function grades of the two groups before and after treatment were evaluated. Results: On the 7th day of treatment, the LVEF, NT-proBNP, urine volume and NYHA cardiac function of the comentional treatment group and the levosimendan group were improved after treatment, and the difference was statistically significant (P<0.05). However, the levosimendan group had higher LVEF, lower NT-proBNP, and higher urine volume than the conventional treatment group,the cardiac function classification of New York improved more significantly (P<0.05).Before and after treatment,Two groups of patients liver function and renal function,eGFR there was no significant difference (P>0.05). Conclusion: Early application of levosimendan in the treatment of chronic heart failure decompensated patients can significantly improve heart failure index, such as LVEF, NT-proBNP, urine output, NYHA heart function classification. It dose not damage liver and kidney function, and have good clinical effect.

Key words： Calcium sensitizer Chronic decompensated congestive heart failure LVEF eGFR NT-proBNP

基金资助:安徽省科技厅年度重点科研项目,(编号:11070403049)

通讯作者: 张小玲, 王翠翠

引用本文:

房晓伟,张小玲. 钙离子增敏剂治疗慢性心力衰竭失代偿患者的临床疗效和安全性观察[J]. 河北医学, 2018, 24(10): 1659-1663.
FANG Xiaowei, ZHANG Xiaoling, WANG Cuicui, et al. Clinical Efficacy and Safety Observation of Calcium Sensitizer in the Treatment of Decompensated Patients with Chronic Heart Failure. HeBei Med, 2018, 24(10): 1659-1663.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2018.10.019 或 http://www.hbyxzzs.cn/CN/Y2018/V24/I10/1659

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