2018 年第 11 期 第 13 卷

左西孟旦对急性心力衰竭患者心功能和血流动力学及炎性因子的影响

Effect of levosimendan on cardiac function, hemodynamics and inflammatory factors in patients with acute heart failure

作者：周红瑜厉旭光颜碧清

英文作者：

单位：315000宁波大学医学院附属医院重症医学科

英文单位：

关键词：急性心力衰竭；左西孟旦；心功能；血流动力学；炎性因子；米力农

英文关键词：

• 摘要：

• 【摘要】目的    探讨左西孟旦对急性心力衰竭患者心功能、血流动力学及炎性因子的影响。方法    选取2015年1月至2017年10月宁波大学医学院附属医院诊断急性心力衰竭患者96例，通过随机数字表法分为对照组和左西孟旦组，每组48例。在常规治疗基础上，对照组采用米力农注射液治疗，左西孟旦组采用左西孟旦注射液治疗。分别于治疗前及治疗后测患者心功能指标［B型脑钠肽（BNP）、左心室射血分数（LVEF）、左心室舒张末期内径（LVDD）］、血流动力学指标［肺毛细血管楔压（PCWP）、肺动脉平均压（PAMP）、心排血指数（CI）、外周血管阻力（SVR）、右心房压］、炎性因子［高敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）］，并进行疗效评估。结果    治疗前2组BNP水平、LVEF、LVDD、PCWP、PAMP、CI、SVR、右心房压、hs-CRP、IL-6、TNF-α水平差异均无统计学意义（均P＞0.05）。治疗后，2组以上指标均较治疗前明显改善，且左西孟旦组BNP水平、LVDD明显低于对照组［（1 133±410）ng/L比（1 781±497）ng/L、（55±10）mm比（58±10）mm］，LVEF明显高于对照组［（46±8）%比（40±7）%］，PCWP、PAMP、SVR及右心房压明显低于对照组［（58±10）mmHg（1 mmHg=0.133 kPa）比（18±9）mmHg、（23±9）mmHg比（27±9）mmHg、（1 196±467）dyn/(s·cm)比（1 507±497）dyn/(s·cm)、（6.3±4.1）mmHg比（6.8±3.9）mmHg］，CI明显高于对照组［（2.9±0.7）L/(min·m2)比（2.6±0.7）L/(min·m2)］，hs-CRP、IL-6、TNF-α水平均明显低于对照组［（1.2±0.7）mg/L比（2.0±0.9）mg/L、（7.1±1.4）ng/L比（9.2±1.6）ng/L、（0.88±0.21）ng/L比（1.23±0.29）ng/L］，差异均有统计学意义（均P＜0.05）。左西孟旦组总有效率明显高于对照组［87.5%（42/48）比75.0%（36/48）］（P＝0.006）。结论    左西孟旦能够明显改善急性心力衰竭患者的心功能、血流动力学及炎症状态，其疗效优于米力农。

• 【Abstract】Objective    To analyze the effect of levosimendan on cardiac function, hemodynamics and inflammatory factors in patients with acute heart failure. Methods    A total of 96 acute heart failure patients admitted from January 2015 to October 2017 in the Affiliated Hospital of Medical School of Ningbo University were randomly divided into levosimendan group and control group, with 48 cases in each group. The control group was treated with milrinone injection. The levosimendan group was treated with levosimendan injection. Cardiac function indexes［B-type natriuretic peptide(BNP), left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVDD)］, hemodynamic parameters［pulmonary capillary wedge pressure(PCWP), pulmonary arterial mean pressure(PAMP), cardiac index(CI), systemic vascular resistance(SVR), right atrial pressure(RAP)］ and inflammatory factors［high-sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6), tumour necrosis factor-α(TNF-α)］ were detected before and after treatment. Therapeutic effect was assessed after treatment. Results    There were no significant differences of BNP, LVEF, LVDD, PCWP, PAMP, CI, SVR, RAP, hs-CRP, IL-6 and TNF-α between groups before treatment（all P＞0.05）. After treatment, the indicators showed significant improvements compared to the baselines; BNP and LVDD in levosimendan group were significantly lower than those in control group［（1 133±410）ng/L vs （1 781±497）ng/L, （55±10）mm vs （58±10）mm］; LVEF in levosimendan group was significantly higher than that in control group［（46±8）% vs （40±7）%］; PCWP, PAMP, SVR and RAP in levosimendan group were significantly lower than those in control group［（58±10）mmHg vs （18±9）mmHg, （23±9）mmHg vs （27±9）mmHg, （1 196±467）dyn/(s·cm) vs （1 507±497）dyn/(s·cm), （6.3±4.1）mmHg vs （6.8±3.9）mmHg］; CI in levosimendan group was significantly higher than that in control group［（2.9±0.7）L/(min·m2) vs （2.6±0.7）L/(min·m2)］; levels of hs-CRP, IL-6 and TNF-α in levosimendan group were significantly lower than those in control group［（1.2±0.7）mg/L vs （2.0±0.9）mg/L, （7.1±1.4）ng/L vs （9.2±1.6）ng/L, （0.88±0.21）ng/L vs （1.23±0.29）ng/L］（all P＜0.05）. The total effective rate in levosimendan group was significantly higher than that in control group［87.5%（42/48） vs 75.0%（36/48）］（P＝0.006）. Conclusion    Levosimendan can improve cardiac function, hemodynamic state and reduce inflammation more significantly than milrinone in treatment of acute heart failure.