左西孟旦治疗高龄老年人左心衰的疗效及安全性研究

Efficacy and safety of levosimendan for left heart failure in the very elderly

摘要:

目的 探讨左西孟旦对高龄老年人左心衰的临床疗效及安全性。方法 选择2014年9月至2015年4月在解放军总医院心内科确诊为慢性左心衰住院的高龄老年患者58例，男21例，女37例，年龄为（86.8±1.5）岁。进行自身前后对比研究，分别在应用左西孟旦治疗前、治疗后3d、治疗后3个月进行血清B型利钠肽（BNP）、左室射血分数（LVEF）、左室短轴缩短率（LVFS）、6min步行试验（6MWT）等指标检测。结果 治疗后3d的血BNP值明显低于治疗前（P＜0.01）；治疗后3d的LVEF，LVFS，6MWT明显优于治疗前（P＜0.01）；治疗后3个月的血BNP值明显低于治疗前（P＜0.01）；治疗后3个月的LVEF，LVFS，6MWT明显高于治疗前（P＜0.01）；治疗前、治疗后3d、治疗后3个月的肝功：丙氨酸氨基转移酶（ALT），天冬氨酸氨基转移酶（AST），谷氨酰胺转移酶（γ-GT），肾功：血肌酐（SCr），血尿素氮（BUN），血尿酸（SUA），均无明显改变（P＞0.05）；治疗前后血压值也无显著变化（P＞0.05）。结论 单次给药左西孟旦对高龄老年心力衰竭患者有疗效且安全可靠。

Abstract:

Objective To determine the clinical efficacy and safety of levosimendan for the very elderly patients with left heart failure. Methods A total of 58 very elderly patients [age: (86.8±1.5) years, 21 males and 37 females] with chronic left heart failure admitted in our department from September 2014 to April 2015 were prospectively recruited in this study. A self-controlled trial was carried out on the efficacy of levosimendan. Serum B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and 6-minute walking test (6MWT) were measured before and in 3 d and 3 months after treatment. Results In 3d after levosimendan treatment, their serum levels of BNP was significantly decreased, and the values of LVEF, LVFS and 6MWT were much better than before treatment (all P＜0.01). After 3 months’ treatment, the BNP level was obviously lower, and the values of LVEF, LVFS and 6MWT were greatly improved than those before treatment (all P＜0.01). There was no significant difference in blood pressure values, liver function parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-transglutaminase (γ-GT)], and renal function indices [serum creatinine (SCr), blood urea nitrogen (BUN), and serum uric acid (SUA)] in the cohort before and in 3d and 3 months after treatment (P＞0.05). Conclusion Single dose levosimendan is efficient and safe in the treatment of heart failure for the very elderly.