当前位置:

网站首页>文章详情

左西孟旦、硝酸甘油及多巴酚丁胺治疗急性失代偿心力衰竭的临床疗效比较

【PDF在线阅读】 【下载PDF】
  • Author:

  • Author Unit:

  • Keywords:

摘要:

目的 分析左西孟旦(LEV)、硝酸甘油(NTG)及多巴酚丁胺(DOB)对急性失代偿心
力衰竭(ADHF)患者心功能及肾功能的影响。方法 选取青海省心脑血管病专科医院2017年1月至2018
年4月期间收治的210例ADHF患者为研究对象。所有患者均给予抗凝、抗血小板、降脂、吸氧、镇静
等常规基础治疗。根据随机数字表法分为DOB组(静脉输注DOB,n=70)、NTG组(静脉输注NTG,
n=70),LEV组(静脉输注LEV,n=70)。治疗72 h后,比较3组患者射血分数(LVEF),N端前脑钠肽
(NT-proBNP),6分钟步行实验(6MWD),超敏C反应蛋白(hs-CRP),肌钙蛋白(cTnI)及肾功能
指标包括肾小球滤过率(GFR),血尿素氮(BUN),血肌酐(Scr),血清胱抑素(Cys-C)及尿量等
指标表达情况。结果 治疗前,3组患者LVEF、NT-proBNP、6MWD及hs-CRP、cTnI水平比较,差异均
无统计学意义(P>0.05)。治疗后,3组患者的LVEF、6MWD及hs-CRP水平较治疗前均明显升高,差
异均有统计学意义(P<0.05);NT-proBNP及cTnI水平较治疗前均明显降低,差异亦均有统计学意义
(P<0.05)。治疗后,NTG组、DOB组及LEV组患者LVEF水平、6MWD及hs-CRP水平依次增高,NTproBNP
及cTnI水平依次降低,组间相比差异均具有统计学意义(P<0.05)。治疗前,3组患者GFR、
BUN、Scr、Cys-C及72 h尿量比较,差异均无统计学意义(P>0.05)。治疗后,NTG组、DOB组上述
指标与治疗前比较,差异均无统计学意义(P>0.05);而LEV组治疗后GFR及72 h尿量高于治疗前,
BUN、Scr、Cys-C低于治疗前,差异均具有统计学意义(P均<0.05)。结论 与硝酸甘油及多巴酚丁胺
治疗相比,左西孟旦更能改善ADHF患者心功能及肾功能。

Abstract:

Objective To analyze the influence of levosimendan (LEV), nitroglycerin (NTG) and dobutamine
(DOB) on heart function and kidney function in patients with acute decompensated heart failure (ADHF). Methods
ADHF patients (n=210) were chosen from Specialist Hospital of Cardiovascular and Cerebrovascular Diseases in
Qinghai Province from Jan. 2017 to Apr. 2018. The patients were divided, according to random digital table, into DOB
group (with intravenous drip of DOB), NTG group (with intravenous drip of NTG) and LEV group (with intravenous drip
of LEV, each n=70). The indexes of left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide
(NT-proBNP), 6-minute walk distance (6MWD), high sensitivity C-reactive protein (hs-CRP), cardiac troponin I
(cTnI), glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum creatinine (SCr), serum cystatin C (Cys C)
and urine volume were compared among 3 groups after treatment for 72 h. Results Before treatment, the comparison
in LVEF, NT-proBNP, 6MWD, and levels hs-CRP and cTnI showed that the difference had no statistical significance
among 3 groups (P>0.05). After treatment, LVEF, 6MWD and hs-CRP level increased significantly (P<0.05), and
levels of NT-proBNP and cTnI decreased significantly (P<0.05) in 3 groups compared with those before treatment.
After treatment, LVEF level, 6MWD and hs-CRP level ascended successively, and levels of NT-proBNP and cTnI
descended successively in NTG group, DOB group and LEV group (P<0.05). Before treatment, the comparison in GFR,
BUN, Scr, Cys-C and 72-h urine volume showed that the difference had no statistical significance among 3 groups
(P>0.05). After treatment, the difference in above indexes had no statistical significance in NTG group and DOB group
(P>0.05) compared with those before treatment. In LEV group, GFR and 72-h urine volume were higher, and levels of
BUN, Scr and Cys-C were lower after treatment than those before treatment (all P<0.05). Conclusion LEV has higher
improving effect on heart function and kidney function compared with NTG and DOB in ADHF patients.

基金项目:

参考文献:

[1] Members WG,Mozaffarian D,Benjamin EJ,et al. Heart Disease and
Stroke Statistics-2016 Update: A Report From the American Heart
Association[J]. Circulation, 2016,133(4):e38-360.
[2] Bueno H,Ross JS,Wang Y,et al. Trends in length of stay and shortterm
outcomes among Medicare patients hospitalized for heart
failure,1993-2006[J]. JAMA,2010,303(21):2141-7.
[3] 朱臻,赵建荣,李紫阳,等. 新活素与多巴酚丁胺治疗急性心力衰
竭的疗效比较及对血浆Gal-3、CysC、ET-1水平的影响[J]. 现代
生物医学进展,2017,17(26):5145-8.
[4] 韩容,赵志刚. 钙离子增敏剂左西孟旦临床应用进展及循证医学
证据[J]. 药品评价,2016,13(18):8-14,45.
[5] 关昌杰,梁鸣,陈敢,等. Cockcroft-Gault公式和中国人MDRD公
式在红斑狼疮患者肾小球滤过率的评估[J]. 广州医药,2018,
49(2):15-8,22.
[6] 张健,安涛. 血管活性药物在急性失代偿心力衰竭中的应用[J].
岭南心血管病杂志,2015,21(1):17-20.
[7] 黄鑫涛,庞学民,李之恒,等. 重组人脑钠肽与硝酸甘油治疗急性
前壁心肌梗死合并失代偿性心力衰竭的疗效比较[J]. 中国循证
心血管医学杂志,2014,6(6):704-7.
[8] 吴冠祺,常平. 静脉注射左西孟坦、多巴酚丁胺对脓毒症休克患
者心肌抑制影响的对照性研究[J]. 标记免疫分析与临床,2016,
23(12):1450-3.
[9] 蒋桔泉,丁世芳. 高敏肌钙蛋白升高的鉴别诊断[J]. 华南国防医
学杂志,2016,30(6):413-4.
[10] Sheng Q,Qiao X,Zhou M,et al. Recent progress in electrochemical
sensing of cardiac troponin by using nanomaterial-induced signal
amplification[J]. Microchimica Acta,2017,184:1573-85.
[11] 张倩,郭畅,魏璐佳,等.左西孟旦对老年急性心肌梗死合并心力衰
竭患者的临床疗效及安全性评价[J].中国医药,2018,13(4):481-4.
[12] 张小龙. 左西孟旦对心力衰竭大鼠离体心脏的保护作用及机制
研究[J]. 中西医结合心脑血管病杂志,2016,14(24):2896-9.
[13] 牡兰,陶谢鑫,于影. 左西孟旦治疗心力衰竭临床研究新进展[J].
内蒙古民族大学学报(自然科学版),2015,30(2):152-5.
[14] 周红瑜,厉旭光,颜碧清.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[J].中国医药,2018,13(11):1605-8.
[15] Ribeiro RA,Rohde LE,Polanczyk CA. Levosimendan in acute
decompensated heart failure: systematic review and meta-analysis[J].
Arq Bras Cardiol,2010,95(2):230-7.
[16] King JB,Shah RU,Sainski-Nguyen A,et al. Effect of Inpatient
Dobutamine versus Milrinone on Out-of-Hospital Mortality in Patients
with Acute Decompensated Heart Failure[J]. Pharmacotherapy,2017,
37(6):662-72.
[17] 许呈扬. HPLC-MSMS法测定人血浆中的左西孟旦及其主要代谢
物[J]. 海峡药学,2016,28(10):261-2.
[18] 许华娟,李先维. 左西孟旦对难治性心力衰竭伴早期肾功能不全
患者心肾功能的影响[J]. 医学理论与实践,2018,31(4):505-6.
  • 2008

  • 1

通讯地址:北京市东城区东四十条南门仓5号
电话: 237499284 邮编:100700
网址:www.ebcvm..org Email: ebcvm_cj@126.com

copyright © 《中国循证心血管医学杂志》编辑部
当您在使用本网站投稿遇到困难时,
请直接将稿件投送到编辑部邮箱ebcvm_cj@126.com