左西孟旦治疗老年顽固性心力衰竭的临床观察

评价左西孟旦(levosimendan)治疗老年性顽固性充血性心力衰竭(心衰)的临床疗效。方法选取年龄大于65岁的老年充血性心衰患者267例,其纽约心功能分级(NYHA)在Ⅲ级或Ⅳ级或介于二者之间、超声心动图证实左室射血分数(LvEF)≤40%、血NTpro-BNP≥1 000μg.L-1,经规范给予洋地黄和(或)米力农、多巴酚丁胺强心,呋塞米、氢氯噻嗪利尿,螺内酯拮抗醛固酮,ACE-Ⅰ类改善预后以及充分抗感染、限盐等纠正诱发因素等治疗2周(第一阶段治疗),症状不能好转,重新评估NYHA心功能分级仍在Ⅲ级或Ⅳ级或介于二者之间、复查心脏彩超证实LvEF仍≤40%、血NTpro-BNP≥1 000μg.L-1、血肌酐≤110μmol.L-1(干式生化法)的患者41例,按随机数字表法分成试验组和对照组。试验组20例,给予左西孟旦治疗;对照组21例,继续原规范纠正心衰治疗。观察2组用药72h后NYHA心功能分级、LvEF、血NTpro-BNP的变化。结果试验组在改善心功能、提高射血分数、降低NTpro-BNP等指标方面与对照组比较有显著优势(P<0.01)。结论左西孟旦对常规治疗方法纠正心衰治疗无效的老年患者,可显著改善心功能、提高射血分数、降低NTpro-BNP。

Effect of Levosimendan on Refractory Heart Failure in Elderly Patients

Objective To evaluate the clinical effect of levosimendan on intractable heart failure in elderly patients.Methods A total of 267 patients with congestive heart failure(over 65 years of age,NYHA class Ⅲ-Ⅳ,LvEF≤40%,and NTpro-BNP≥1 000 μg·L-1) were regularly treated with digitalis and/or milrinone,dobutamine,frusemide,aldosterone,panurin,ACE-I,anti-infection and salt restriction for 2 weeks.Forty-one patients without symptom improvement were re-evaluated and presented in NYHA class Ⅲ-Ⅳ,LvEF≤40%,NTpro-BNP≥1 000 μg·L-1,and serum creatinine≤110 μmol·L-1.These patients were treated with levosimendan(experimental group,n=20) or continuously given regular treatment(control group,n=21).The changes in NYHA classification,LvEF and NTpro-BNP were observed 72 hours after treatment.Results Compared with control group,NYHA functional classification,LvEF and Ntpro-BNP were significantly improved in experimental group(P<0.01).Conclusion Levosimendan can improve heart function,increase LvEF and reduce NTpro-BNP in elderly patients with intractable heart failure.