2018 年第 4 期 第 13 卷

左西孟旦对老年急性心肌梗死合并心力衰竭患者的临床疗效及安全性评价

Therapeutic effect and safety of levosimendan on elderly patients with acute myocardial infarction complicated with heart failure

作者：张倩郭畅魏璐佳姚威王喜福张慧敏宋荟芬田雪王娱师树田王春梅聂绍平

英文作者：

单位：100029首都医科大学附属北京安贞医院急诊危重症中心

英文单位：

关键词：急性心肌梗死;心力衰竭;左西孟旦

英文关键词：

• 摘要：

• 目的    探讨左西孟旦治疗老年急性心肌梗死（AMI）合并心力衰竭的临床效果及安全性。方法    连续入选2016年1月至2017年6月在首都医科大学附属北京安贞医院急诊住院的老年AMI合并心力衰竭患者346例,其中接受抗血小板、抗凝、利尿、扩血管、对症治疗等常规治疗219例（对照组），常规治疗联合左西孟旦治疗（观察组）127例,观察2组患者治疗24 h的生命体征变化、治疗1周的药物安全性和心功能以及治疗期间主要心血管不良事件的发生率。结果    治疗24 h，观察组心率、收缩压、呼吸频率均低于治疗前，且观察组心率和呼吸频率低于对照组［（84±8）次/min比（92±9）次/min,（21±3）次/min比（24±4）次/min］（均P<0.05）。治疗1周后观察组肌酐低于对照组［(81±16)μmol/L比（94±17）μmol/L］（P<0.05）。治疗1周后，2组患者的B型利钠肽、高敏C反应蛋白均低于治疗前，且观察组低于对照组；观察组左心室射血分数、左心室短轴缩短指数均高于治疗前和对照组（均P<0.05）。治疗1周内观察组的心力衰竭加重率和病死率低于对照组（均P<0.05）。结论    左西孟旦治疗老年AMI合并心力衰竭可降低短期病死率，且用药安全有效。

• 【Abstract】Objective    To observe the therapeutic effect and safety of levosimendan on elderly patients with acute myocardial infarction complicated with heart failure. Methods    Totally 346 elderly patients with acute myocardial infarction complicated with heart failure were enrolled from January 2016 to June 2017 in Beijing Anzhen Hospital, Capital Medical University. Conventional treatments including antiplatelet, anticoagulant, diuretic, vasodilative and symptomatic treatments were performed in 219 patients（control group）. Intravenous injection of levosimendan combined with conventional treatments were performed in 127 patients（observation group）. Vital signs, heart function and major adverse cardiovascular events were analyzed. Results   Twenty-four hours after treatment, heart rate, systolic pressure and respiratory rate were significantly lower than those before treatment in both groups; heart rate and respiratory rate in observation group were significantly lower than those in control group［（84±8）times/min vs （92±9）times/min, （21±3）times/min vs （24±4）times/min］（P<0.05）. One week after treatment, serum creatinine level in observation group was significantly lower than that in control group［(81±16)μmol/L vs （94±17）μmol/L］（P<0.05）; levels of B-type natriuretic peptide and high-sensitive C-reactive protein were significantly lower than those before treatment in both groups; levels of B-type natriuretic peptide and high-sensitive C-reactive protein in observation group were significantly lower than those in control group; left ventricular ejection fraction and left ventricular shortening fraction in observation group were significantly lower than those in control group and those before treatment（all P<0.05）. Heart failure aggravation rate and mortality rate in 1 week in observation group were significantly lower than those in control group（P<0.05）. Conclusion    Levosimendan is effective and safe in treating elderly patients with acute myocardial infarction complicated with heart failure.