急性心力衰竭患者使用左西孟旦治疗的效果及安全性观察

doi:10.3760/cma.j.issn.1007-1245.2024.12.021

摘要/Abstract

摘要：

目的　本研究旨在评估左西孟旦治疗急性心力衰竭（AHF）患者的应用效果。方法　选取2021年1月至2023年10月期间铜川市人民医院收治的98例AHF患者，根据受试者进入研究的时间顺序随机分为对照组（49例）和观察组（49例）。对照组男27例，女22例；年龄（67.14±6.65）岁；美国纽约心脏病协会（NYHA）分级：Ⅱ级20例，Ⅲ级15例，Ⅳ级14例；采用常规方案治疗。观察组男28例，女21例；年龄（66.57±6.64）岁；NYHA分级：Ⅱ级19例，Ⅲ级16例，Ⅳ级14例；采用常规方案加左西孟旦（静脉注射）治疗。两组均治疗4周。比较两组患者治疗前和治疗后临床症状（胸闷及呼吸困难）持续时间、心肌酶水平［髓过氧化物酶（MPO）、N末端脑钠肽前体（NT-proBNP）、心肌肌钙蛋白I（cTnI）及基质金属蛋白酶9（MMP-9）］、心功能指标［左心室内径（LVD）、左心房内径（LAD）、左心室短轴缩短率（LVFS）、三尖瓣环收缩期位移（TAPSE）、心率（HR）］及治疗期间不良反应的发生情况。采用独立样本t检验和χ²检验。结果　治疗后，观察组胸闷［（1.82±0.37）min/次］、呼吸困难［（1.68±0.39）min/次］持续时间均短于对照组［（2.49±0.42）min/次、（2.59±0.41）min/次］，差异均有统计学意义（均P<0.05）；观察组MPO［（2.89±0.61）pg/L］、NT-proBNP［（2.05±0.67）g/L］、cTnI［（2.58±0.56）μg/L］、MMP-9［（58.58±7.41）μg/L］水平均低于对照组［（4.36±0.83）pg/L、（4.69±1.54）g/L、（2.97±0.63）μg/L、（90.64±8.84）μg/L］，差异均有统计学意义（均P<0.05）；观察组LVD［（40.44±4.84）mm］和LVFS［（31.41±2.54）%］均高于对照组［（32.65±4.64）mm、（22.63±3.68）%］，LAD［（29.89±3.38）mm］、TAPSE［（15.85±3.03）mm］和HR［（69.85±8.23）次/min］均低对照组［（37.65±4.65）mm、（17.59±3.13）mm、（86.52±8.51）次/min］，差异均有统计学意义（均P<0.05）。治疗期间两组患者不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　左西孟旦在治疗AHF患者中显示出良好的效果和安全性，可作为该病症的有效治疗选择。

关键词:

急性心力衰竭, 左西孟旦, 心肌酶, 心功能, 安全性

Abstract:

Objective　This study aimed to evaluate the clinical application effect of Levosimendan in patients with acute heart failure (AHF). Methods　A total of 98 patients with AHF admitted to Tongchuan People's Hospital from January 2021 to October 2023 were included in this study and were randomly divided into two groups, with 49 patients in each group. There were 27 males and 22 females in the control group, the age was (67.14±6.65) years old, and the New York Heart Association (NYHA) grading was grade Ⅱ in 20 cases, grade Ⅲ in 15 cases, and grade Ⅳ in 14 cases. There were 28 males and 21 females in the observation group, the age was (66.57±6.64) years old, and the NYHA grading was grade Ⅱ in 19 cases, grade Ⅲ in 16 cases, and grade Ⅳ in 14 cases. The control group received standard treatment, and the observation group received standard treatment plus Levosimendan (intravenous injection), with a treatment period of 4 weeks. The duration of clinical symptoms (chest tightness and shortness of breath), myocardial enzyme levels [myeloperoxidase (MPO), N-terminal pro B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), and matrix metalloproteinase 9 (MMP-9)], and cardiac function indicators [left ventricular diameter (LVD), left atrial diameter (LAD), Left ventricular short axis shortening fraction (LVFS), tricuspid annular plane systolic excursion (TAPSE), and heart rate (HR)] before and after treatment, as well as the occurrence of adverse reactions during treatment were compared between the two groups. Independent sample t test and χ² test were used. Results　After treatment, the duration of chest tightness [(1.82±0.37) min/time] and dyspnea [(1.68±0.39) min/time] in the observation group were shorter than those in the control group [(2.49±0.42) min/time and (2.59±0.41) min/time], with statistically significant differences (both P<0.05). The levels of MPO [(2.89±0.61) pg/L], NT-proBNP [(2.05±0.67) g/L], cTnI [(2.58±0.56) μg/L], and MMP-9 [(58.58±7.41) μg/L] in the observation group were lower than those in the control group [(4.36±0.83) pg/L, (4.69±1.54) g/L, (2.97±0.63) μg/L, and (90.64±8.84) μg/L], with statistically significant differences (all P<0.05). The levels of LVD [(40.44±4.84) mm] and LVFS [(31.41±2.54)%] in the observation group were higher than those in the control group [(32.65±4.64) mm and (22.63±3.68)%], while the levels of LAD [(29.89±3.38) mm], TAPSE [(15.85±3.03) mm], and HR [(69.85±8.23) beats/min] were lower than those in the control group [(37.65±4.65) mm, (17.59±3.13) mm, and (86.52±8.51) beats/min], with statistically significant differences (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion　Levosimendan shows good efficacy and safety in patients with AHF and can be considered an effective treatment option for this condition.

Key words:

Acute heart failure, Levosimendan, Myocardial enzymes, Cardiac function, Safety

郭振王涛丽李乃杰.

急性心力衰竭患者使用左西孟旦治疗的效果及安全性观察 [J]. 国际医药卫生导报, 2024, 30(12): 2039-2043.

Guo Zhen, Wang Taoli, Li Naijie.

Effectiveness and safety of Levosimendan treatment in patients with acute heart failure [J]. International Medicine and Health Guidance News, 2024, 30(12): 2039-2043.

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