CAJ | 학술논문

目的：评价左西孟旦治疗失代偿性心力衰竭患者的近期疗效。方法将160例心力衰竭患者随机分为左西孟旦组和对照组，每组80例。左西孟旦组在常规心力衰竭治疗的基础上加用左西孟旦静脉维持24 h。比较治疗后两组左心室射血分数（LVEF）及血浆 B 型尿钠肽（BNP）变化，比较两组住院期间及3个月死亡、再住院及联合终点（死亡或再住院）发生率。结果排除治疗前 LVEF 的影响，治疗后左西孟旦组 LVEF 较对照组增加[（31.8±6.1）%与（31.3±5.7）%，P =0.016]。在冠心病亚组中，左西孟旦组 LVEF 增加优于对照组[（32.6±5.8）%与（32.4±5.3）%，P =0.031]。排除治疗前 lg（BNP）的影响，治疗后左西孟旦组 lg（ BNP）低于对照组[（2.7±0.5）pg/ ml与（2.9±0.3）pg/ ml，P <0.01]。治疗后左西孟旦组与对照组院内病死率及3个月内病死率比较差异均无统计学意义（20.0%与23.7%和30.0%与40.0%，P =0.492和 P =0.180），而联合终点事件则明显少于对照组（51.2%与70.0%，P =0.031）。在冠心病亚组中，左西孟旦组3个月再住院及联合终点事件发生率均较对照组显著降低（20.4%对37.75和46.9%对73.6%，P =0.014和 P =0.010）。结论左西孟旦治疗失代偿性心力衰竭患者的近期疗效优于常规治疗，且对冠心病患者疗效优于非冠心病患者。
목적：평개좌서맹단치료실대상성심력쇠갈환자적근기료효。방법장160례심력쇠갈환자수궤분위좌서맹단조화대조조，매조80례。좌서맹단조재상규심력쇠갈치료적기출상가용좌서맹단정맥유지24 h。비교치료후량조좌심실사혈분수（LVEF）급혈장 B 형뇨납태（BNP）변화，비교량조주원기간급3개월사망、재주원급연합종점（사망혹재주원）발생솔。결과배제치료전 LVEF 적영향，치료후좌서맹단조 LVEF 교대조조증가[（31.8±6.1）%여（31.3±5.7）%，P =0.016]。재관심병아조중，좌서맹단조 LVEF 증가우우대조조[（32.6±5.8）%여（32.4±5.3）%，P =0.031]。배제치료전 lg（BNP）적영향，치료후좌서맹단조 lg（ BNP）저우대조조[（2.7±0.5）pg/ ml여（2.9±0.3）pg/ ml，P <0.01]。치료후좌서맹단조여대조조원내병사솔급3개월내병사솔비교차이균무통계학의의（20.0%여23.7%화30.0%여40.0%，P =0.492화 P =0.180），이연합종점사건칙명현소우대조조（51.2%여70.0%，P =0.031）。재관심병아조중，좌서맹단조3개월재주원급연합종점사건발생솔균교대조조현저강저（20.4%대37.75화46.9%대73.6%，P =0.014화 P =0.010）。결론좌서맹단치료실대상성심력쇠갈환자적근기료효우우상규치료，차대관심병환자료효우우비관심병환자。
Objective To evaluate the shor-term efficacy of levosimendan on patients with de-compensated heart failure. Methods One hundred and sixty patients with heart failure were randomly divided into levosimendan group and control group,with 80 cases in each group. Continuous infusion of levosimendan on the basis of conventional therapy was administered for 24 hours in levosimendan group. The left ventricular ejection fraction(LVEF)and plasma B-type natriuretic peptide( BNP)levels after treatment between the two groups were compared respectively,and the hospital mortality,and 3-month followed-up mortality,readmission or composite outcome(such as death or readmission)were compared. Results After the adjusted effects of LVEF at baseline,the LVEF after treatment in levosimendan group (n = 70)significantly was higher than that in control group( n = 65)[(31. 8 ± 6. 1)% vs(31. 3 ± 5. 7)% ,P = 0. 016]. From the primary aetiology stratified,levosimendan was associated with a larger improvement of LVEF in sub-group of coronary heart disease[(32. 6 ± 5. 8)% vs(32. 4 ± 5. 3)% ,P =0. 031]. With the adjusted effects of l g(BNP)before treatment,the l g(BNP)after treatment in levosi-mendan group(n = 47)had a sharper decrease than that in control group(n = 49)[(2. 7 ± 0. 5)pg / ml vs(2. 9 ± 0. 3)pg / ml,F = 15. 30,P < 0. 01]. Analysis of hospital mortality and followed-up mortality at 3 months showed no difference between the levosimendan group and the control group(20. 0% vs 23. 7% , 30. 0% vs 40. 0% ,P = 0. 492 and P = 0. 180),but composite outcome events was lower than the control group(51. 2% vs. 70. 0% ,P =0. 031). Moreover,levosimendan was associated with a lower incidence rate of readimission and composite outcome events in sub-group of coronary heart disease(20. 4% vs 37. 8% , 46. 9% vs 73. 6% ,P = 0. 014 and P = 0. 010). Conclusions Levosimendan is superior to conventional therapy in short-term efficacy for patients with decompensated heart failure,with better outcomes in coro-nary heart disease compared with heart failure from other aetiologies.