静脉注射左西孟旦治疗晚期严重心力衰竭患者的疗效分析

doi:10.3969/j.issn.1002-1949.2018.08.012

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摘要目的评价左西孟旦治疗晚期严重心力衰竭患者的效果。方法收集2015-09~2017-10在赤峰市医院重症医学科(ICU)救治的晚期严重心力衰竭患者60例，采用数字表法随机分为对照组（C组）和试验组（T组），每组30例。C组给予常规治疗加用多巴酚丁胺4 μg/(kg·min)持续泵注24 h，T组给予常规治疗加用左西孟旦0.1 μg/(kg·min)持续泵注24 h。在治疗前（T0）、治疗后24 h（T1）和治疗后72 h（T2）三个时间点：记录N-端脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、动静脉二氧化碳分压差值(GAP)等心功能生化指标，记录中心静脉压(CVP)、心率(HR)等血流动力学指标，记录左室收缩末期容量(LVESV)、左室舒张末期容量(LVEDV)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左室缩短分数(LVSF)等左心功能相关指标，记录右室射血分数(RVEF)、右室横径(RVLD)、右室前后径(RVDD)、肺动脉收缩压(PASP)等右心功能相关指标，记录血肌酐(SCr)、谷丙转氨酶(ALT)、谷草转氨酶(AST)等肝肾功能指标。结果两组患者性别、APACHE Ⅱ评分、年龄、BMI、NYHA分级等一般资料比较差异无统计学意义(P＞0.05)。与T0时和C组比较，在T1、T2时T组患者NT-proBNP、CK-MB、GAP、CVP、HR明显降低(P＜0.05)，LVEF、LVSF明显升高和LVESV、EPSS、LVESD明显降低(P＜0.05)，RVEF明显升高和RVLD、RVDD、PASP明显降低(P＜0.05)，SCr、ALT、AST明显降低(P＜0.05)。结论在常规治疗基础上加用左西孟旦24 h可明显改善晚期严重心力衰竭患者心功能，治疗效果显著。

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	杨飞
	王少华
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	陈壮

关键词 ：左西孟旦, 严重心力衰竭, N-端脑钠肽前体（NT-proBNP）, 肌酸激酶同工酶（CK-MB）

通讯作者: 陈壮（1962-），男，主任医师，E-mail：cfsicu@163.com。

作者简介: 杨飞（1981-），男，硕士，主治医师，E-mail：1824019829@163.com。

引用本文:

杨飞，王少华，赵丽娜，王蕴英，陈壮. 静脉注射左西孟旦治疗晚期严重心力衰竭患者的疗效分析[J]. 中国急救医学, 2018, 38(8): 706-710.
Yang Fei, Wang Shao-hua, Zhao Li-na, Wang Yun-ying, Chen Zhuang. Efficacy of intravenous injection of levosimendan in the treatment of advanced patients with severe heart failure. Chinese Journal of Critical Care Medicine, 2018, 38(8): 706-710.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.08.012 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I8/706

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