左西孟旦改善急性心肌梗死伴心力衰竭患者近期血流动力学的研究

Levosimendan results in short-term improvement in hemodynamics of acute myocardial infarction patients with heart failure

摘要:

目的 观察左西孟旦对急性心肌梗死伴心力衰竭患者血流动力学的影响。方法 入选2012年8月至2014年11月期间解放军总医院心内科收治的老年缺血性心脏病患者112例，随机分为两组：对照组（n＝56）和左西孟旦组（n＝56）。对照组给予常规利尿、扩血管等治疗，治疗组在常规治疗的基础上加用左西孟旦。采用脉搏指示连续心排量（PICCO）监测系统监测两组患者治疗前后心脏指数（CI）、全心舒张末容积指数（GEDI）、全身血管阻力指数（SVRI）变化情况并进行比较；应用彩色多普勒超声诊断仪监测两组患者治疗前后左室射血分数（LVEF）；同时监测两组患者脑尿钠肽（BNP）的变化以及心功能改善情况。结果 两组患者治疗前后比较，GEDI、CI、SVRI、LVEF、BNP值的改变均达到统计学意义，且治疗后左西孟旦组患者的各指标较对照组患者也明显改善，差异均具统计学意义（P＜0.05）。与对照组患者相比，左西孟旦组的总有效率显著提高（92.85% vs 66.07%，P＜0.05）。结论 左西孟旦可以改善急性心肌梗死伴心力衰竭患者近期血流动力学。

Abstract:

Objective To determine the effect of levosimendan on the hemodynamics in the patients who suffered from acute myocardial infarction with heart failure. Methods A total of 112 patients with ischemic heart disease treated in our hospital from August 2012 to November 2014 were recruited in this study, and then randomly divided into control group and levosimendan group, with 56 cases in each group. The control group was treated with conventional diuretic and vasodilator therapy, while the levosimendan group was given levosimendan in addition. Pulse-indicated continuous cardiac output (PICCO) monitoring system was used to measure cardiac index (CI), global end-diastolic volume index (GEDI), and systemic vascular resistance index (SVRI), and the results were compared between the 2 groups. Left ventricular ejection fraction (LVEF) was detected by color Doppler ultrasound examination, and the changes of brain natriuretic peptide (BNP) and heart function improvement were observed at the same time. Results LVEF, CI, GEDI, SVRI and BNP were significantly improved in the both groups after treatment, and those of the levosimendan group were more significant than those of the control group (all P＜005). The total significant efficiency was obviously higher in the levosimendan group than in the control group (92.85% vs 66.07%, P＜005). Conclusion Levosimendan exerts short-term improvement in hemodynamics of acute myocardial infarction patients with heart failure.