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目的:对比分析失代偿性心力衰竭患者中单剂与重复左西孟坦静脉注射治疗的疗效差异。方法:入选我院连续收治的失代偿性心力衰竭(NYHA心功能分级Ⅲ~Ⅳ级,左室射血分数低于40%)患者共89例,随机分入单剂组(44例)和重复组(45例)。所有患者均在常规抗心衰治疗(个体化合理应用肾素-血管紧张素-醛固酮系统抑制剂、β受体阻滞剂、利尿剂、洋地黄等)的基础上给予左西孟坦针剂标准治疗(初始负荷剂量12μg·kg-1静脉推注10min、继以0.2μg·kg-1·min-1的剂量微泵持续静脉注射24h)。重复组患者1个月后再次给予上述剂量左西孟坦治疗。比较两组首次治疗后3个月的心功能分级、超声心动图、血N末端脑钠肽前体(NT-proBNP)水平的差异。结果:与单剂组患者相比,重复组患者的NYHA心功能分级改善更明显[(-1.02±0.79)∶(-1.51±0.66),P<0.01];左室射血分数改善[(2.9±7.1)%∶(6.7±8.1)%,P<0.05]及心肌做功指数改善[(-0.05±0.14)∶(-0.22±0.13),P<0.01]程度均达到统计学差异;血NT-proBNP水平降幅显著[(-822.6±454.2)pg/ml∶(-1 188.0±422.6)pg/ml,P<0.01]。结论:对于失代偿性心力衰竭患者在单剂左西孟坦治疗1个月后再次重复给药,可进一步改善患者的心功能水平。
OBJECTIVE: To compare the efficacy of intravenous monotherapy with levocentan injection in patients with decompensated heart failure. Methods: A total of 89 patients with decompensated heart failure (NYHA functional class Ⅲ ~ Ⅳ and LV ejection fraction below 40%) admitted to our hospital were randomly divided into single dose group (44 patients) and Repeat group (45 cases). All patients were given levosimendan standard on the basis of conventional anti-heart failure treatment (individual rational use of renin-angiotensin-aldosterone system inhibitors, β-blockers, diuretics, digitalis, etc.) (Initial dose of 12μg · kg-1 intravenous injection of 10min, followed by a dose of 0.2μg · kg-1 · min-1 micro-pump continuous intravenous injection of 24h). The patients in the repeat group were given levosimendan once again after one month. The difference of cardiac function grade, echocardiogram and N-terminal pro-brain natriuretic peptide (NT-proBNP) level between the two groups after 3 months of treatment was compared. Results: NYHA cardiac function improved more significantly in the repeat group compared with those in the single dose group (-1.02 ± 0.79 vs -1.51 ± 0.66, P <0.01), and the left ventricular ejection fraction improved (2.9 (P <0.05)], and the improvement of myocardial work function index [(-0.05 ± 0.14) :( -0.22 ± 0.13), P <0.01] The level of proBNP decreased significantly (P <0.01), (-822.6 ± 454.2) pg / ml: (-1 188.0 ± 422.6) pg / ml. CONCLUSIONS: Patients with decompensated heart failure can be further rehabilitated in their cardiac function by repeated administration of a single dose of levosimendan administered one month later.