2021 年第 4 期 第 16 卷

左西孟旦注射液与注射用重组人脑利钠肽治疗重症顽固性心力衰竭的临床效果比较

Comparison of the curative effects of levosimendan and recombinant human brain natriuretic peptide for injectionin on severe refractory heart failure

作者：包恩泽1皮林1李贵华1詹小娜1徐世莹1叶芳2郑博林1刘军1

英文作者：Bao Enze1 Pi Lin1 Li Guihua1 Zhan Xiaona1 Xu Shiying1 Ye Fang2 Zheng Bolin1 Liu Jun1e

单位：1北京市垂杨柳医院清华大学附属垂杨柳医院心内科100022；2北京市垂杨柳医院清华大学附属垂杨柳医院血液科100022

英文单位：1Department of Cardiology Beijing Chuiyangliu Hospital Tsinghua University Beijing 100022 China; 2Department of Hematology Beijing Chuiyangliu Hospital Tsinghua University Beijing 100022 China

关键词：顽固性心力衰竭；左西孟旦；注射用重组人脑利钠肽；血流动力学；炎症因子

英文关键词：Refractoryheartfailure;Levosimendan;Recombinanthumanbrainnatriureticpeptideforinjection;Hemodynamics;Inflammatoryfactors

• 摘要：

• 目的 比较左西孟旦注射液与注射用重组人脑利钠肽治疗重症顽固性心力衰竭(RHF)的临床效果。方法 选取2018年5月至2020年5月清华大学附属垂杨柳医院诊治的重症RHF患者178例，采用随机数字表法分为观察组、对照组，各89例。对照组静脉滴注注射用重组人脑利钠肽治疗；观察组静脉滴注左西孟旦注射液治疗。比较2组治疗前及治疗7 d时心功能［左心室射血分数（LVEF）、左心室收缩末期内径(LVESD)、左心室舒张末期内径（LVEDD）、心脏指数及血清N末端B型脑钠肽前体（NT-proBNP）］、血流动力学［平均动脉压(MAP)、肺毛细血管契压(PCWP)］和炎症因子［白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、高敏C反应蛋白(hs-CRP)］水平。比较2组治疗的总有效率及不良反应发生情况。结果 治疗7 d时2组LVEF、心脏指数均高于治疗前，LVESD、LVEDD、NT-proBNP、MAP、PCWP、IL-6、hs-CRP、TNF-α水平均低于治疗前，且观察组LVEF、心脏指数均高于对照组，LVESD、LVEDD、NT-proBNP、MAP、PCWP、IL-6、hs-CRP、TNF-α均低于对照组（均P＜0.05）。观察组治疗总有效率明显高于对照组［95.5%(85/89)比86.5%(77/89)］（P=0.036）。2组不良反应发生率比较差异无统计学意义（P=0.387）。结论 左西孟旦注射液与注射用重组人脑利钠肽均可改善重症RHF患者心功能，改善血流动力学紊乱，减轻炎症反应，具有较好的疗效，但左西孟旦总有效率更高。

• Objective To compare the effects of levosimendan and recombinant human brain natriuretic peptide for injection(rhBNP) on severe refractory heart failure (RHF). Methods From May 2018 to May 2020, 178 severe RHF patients diagnosed and treated in Beijing Chuiyangliu Hospital, Tsinghua University were enrolled. They were randomly divided into observation group and control group, with 89 cases in each group. The control group was treated with rhBNP intravenous drip. The observation group was treated with levosimendan injection intravenous drip. Cardiac function ［left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), cardiac index (CI) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP)］, hemodynamics［mean arterial pressure (MAP) and pulmonary capillary wedge pressure (PCWP)］, and inflammatory factors ［interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) and high-sensitivity C-reactive protein (hs-CRP)］ levels were compared between the two groups before and 7 d after treatment. The total effective rate and occurrence of adverse reactions were compared between the two groups. Results After treatment for 7 d, LVEF and CI of two groups were higher than those before treatment, LVESD, LVEDD, NT-proBNP, MAP, PCWP, IL-6, hs-CRP and TNF-α levels of two groups were lower than those before treatment, LVEF and CI of observation group were higher than those of control group, and LVESD, LVEDD, NT-proBNP, MAP, PCWP, IL-6, hs-CRP, TNF-α levels of observation group were lower than those of control group(all P＜0.05). The total effective rate of the observation group was significantly higher than that of the control group ［95.5%(85/89) vs 86.5%(77/89)］(P=0.036). There was no significant difference in the incidence of adverse reactions between the two groups(P=0.387). Conclusion Both levosimendan and rhBNP can improve the cardiac function of severe RHF patients, improve hemodynamic disorder and reduce inflammation, and showing great effect, but the total effective rate of levosimendan is more.