左西孟旦对高龄老年慢性心力衰竭急性加重期患者的疗效及安全性

Efficacy and safety of levosimendan in treatment of acute exacerbation of chronic heart failure for very elderly patients

摘要:

目的 观察左西孟旦对高龄老年慢性心力衰竭急性加重期患者的疗效及安全性。方法 选取2016年1月至2019年2月漳州正兴医院及解放军第909医院高龄老年慢性心力衰竭急性加重患者47例。采用随机数表法将患者分为2组,治疗组24例和对照组23例。对照组采用规范治疗,治疗组在规范治疗的基础上加用左西孟旦,术后随访3个月。比较2组治疗前后的心脏超声检查结果、血清氨基末端B型利钠肽前体(NT-proBNP)水平、急性发作时纽约心脏协会(NYHA)心功能分级以及随访3个月期间的因心力衰竭反复再住院情况。采用SPSS 17.0统计学软件进行数据处理。结果 治疗组与对照组患者治疗后及3个月随访时收缩压及心率比较,差异无统计学意义(P＞0.05)。治疗后5d及3个月随访时,心脏超声检查提示治疗组左室射血分数优于对照组(48.6%±11.9% 和 44.5%±11.4%,47.8%±12.1% 和 43.6%±11.7%),治疗组NT-proBNP低于对照组[(2437.5±1104.8) pg/L 和 (2926.3±1248.2) pg/L, (2649.1±1155.6) pg/L 和 (3327.8±1293.7) pg/L],差异均有统计学意义(均P＜0.05)。治疗组NYHA分级优于对照组(P＜0.05)。3个月随访期间,因心力衰竭加重再次住院患者治疗组[1例(4.2%)]少于对照组[7例(30.4%)],差异有统计学意义(P＜0.05)。结论 左西孟旦对高龄老年慢性心力衰竭急性加重期患者安全有效。

Abstract:

Objective To observe the efficacy and safety of levosimendan in the treatment of very elderly patients with acute exacer-bation of chronic heart failure. Methods A total of 47 very elderly patients with acute exacerbation of chronic heart failure admitted to the Zhangzhou Zhengxing Hospital and No.909 Hospital of PLA from January 2016 to February 2019 were recruited in this study. They were randomly divided into control group (conventional treatment, n=23) and treatment group (conventional treatment+levosimendan, n=24). All patients were followed up for at least three months. The results of echocardiography, serum level of N-terminal pro-brain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) Functional Classification at acute attack, and heart failure readmission during 3-month follow-up were compared between the two groups. SPSS statistics 17.0 was used for data processing. Results There were no statistic differences in systolic blood pressure and heart rate immediately and in 3 month after treatment between the 2 groups (P>0.05). At 5 d and 3 months after treatment, the results of echocardiography revealed that left ventricular ejction fraction were better in the treatment than the control group [(48.6±11.9)% vs (44.5±11.4)%; (47.8±12.1)% vs (43.6±11.7)%, P<0.05]. At the same time point, serum NT-proBNP level was significantly lower in the treatment group than the control group (2437.5±1104.8 vs 2926.3±1248.2 pg/L; 2649.1±1155.6 vs 3 327.8±1 293.7 pg/L, P<0.05). And the treatment group obtained better NYHA class than the control group (P<0.05). During the 3-month follow-up, the readmission rate due to heart failure was obviously lower in the treatment group than the control group (4.2% vs 30.4%, 1 vs 7 cases, P<0.05). Conclusion Levosimendan is effective and safe in the treatment of very elderly patients with acute exacerbation of chronic heart failure.