CAJ | 학술논문

目的探讨常规治疗基础上分别联用左西孟旦和米力农治疗失代偿心力衰竭的近期临床疗效及安全性.方法 180例心力衰竭患者(NYHA心功能Ⅲ～Ⅳ级)随机(随机数字法)分为对照组、米力农组和左西孟旦组各60例.米力农组在常规心衰药物治疗基础上加用米力农静脉维持72 h,左西孟旦组加用左西孟旦静脉维持24 h.比较治疗前、后的左心室射血分数(LVEF)、左室舒张末期内径(LVDD)及B型利钠肽(BNP)变化,比较3组心功能改善情况及院内病死率,并进行3个月随访.结果治疗后左西孟旦组LVEF高于对照组[(32.0±6.3)％vs.(30.6±5.5)％,P =0.007].与治疗前比较,治疗后对照组、米力农组和左西孟旦组BNP质量浓度分别降低444.0(-74.0,1068.0) pg/mL、469.0 (141.5,1151.5) pg/mL和936.5(437.8,1566.8)pg/mL (P ＜0.01);与对照组和米力农组比较,左西孟旦组BNP下降更为显著(t=3.256,P=0.004和t=2.665,P=0.026).治疗5d后左西孟旦组心功能好转至少达到有效的可能性是对照组的2.036倍(95％CI:1.030～4.028,P=0.041).3组院内及3个月病死率、再住院率差异均无统计学意义(P＞0.05),但3个月联合终点事件发生率左西孟旦组较米力农组显著降低(50.0％vs.70.0％,HR=0.573,95％ CI:0.358 ～0.917,P=0.020).结论左西孟旦治疗失代偿性心力衰竭的近期疗效优于米力农和常规治疗.
목적 탐토상규치료기출상분별련용좌서맹단화미력농치료실대상심력쇠갈적근기림상료효급안전성.방법 180례심력쇠갈환자(NYHA심공능Ⅲ～Ⅳ급)수궤(수궤수자법)분위대조조、미력농조화좌서맹단조각60례.미력농조재상규심쇠약물치료기출상가용미력농정맥유지72 h,좌서맹단조가용좌서맹단정맥유지24 h.비교치료전、후적좌심실사혈분수(LVEF)、좌실서장말기내경(LVDD)급B형리납태(BNP)변화,비교3조심공능개선정황급원내병사솔,병진행3개월수방.결과 치료후좌서맹단조LVEF고우대조조[(32.0±6.3)％vs.(30.6±5.5)％,P =0.007].여치료전비교,치료후대조조、미력농조화좌서맹단조BNP질량농도분별강저444.0(-74.0,1068.0) pg/mL、469.0 (141.5,1151.5) pg/mL화936.5(437.8,1566.8)pg/mL (P ＜0.01);여대조조화미력농조비교,좌서맹단조BNP하강경위현저(t=3.256,P=0.004화t=2.665,P=0.026).치료5d후좌서맹단조심공능호전지소체도유효적가능성시대조조적2.036배(95％CI:1.030～4.028,P=0.041).3조원내급3개월병사솔、재주원솔차이균무통계학의의(P＞0.05),단3개월연합종점사건발생솔좌서맹단조교미력농조현저강저(50.0％vs.70.0％,HR=0.573,95％ CI:0.358 ～0.917,P=0.020).결론 좌서맹단치료실대상성심력쇠갈적근기료효우우미력농화상규치료.
Objective To evaluate the short-term clinical efficacy and safety of administration of levosimendan or milrinone added to conventional therapy in patients with decompensated heart failure.Methods A total of 180 patients admitted due to heart failure [NYHA (New York Heart Association) class Ⅲ or Ⅳ] were randomly (random number) divided into control group,milrinone group and levosimendan group (n =60,each group).A continuous infusion of milrinone added to conventional therapy was administered for 72 hours in milrinone group,while administration of levosimendan for 24 hours in levosimendan group.The changes in left ventricular ejection fraction (LVEF),left ventricle end-diastolic diameter (LVDD) and B-type natriuretic peptide (BNP) plasma level were compared between before and after treatment,respectively,and comparisons of improvement in cardiac function (NYHA class) and hospital mortality were carried out among three groups.Patients were further followed up at 3 months after treatment.Results The LVEF in levosimendan group after treatment had significantly more increased than that in control group [(32.0±6.3)％ vs.(30.6 ±5.5)％,P =0.007].Compared BNP before treatment,the sums of BNP deducted were 444.0 (-74.0,1068.0) pg/mL,469.0 (141.5,1151.5) pg/mL and 936.5 (437.8,1566.8) pg/mL in control group,milrinone group and levosimendan group,respectively after treatment (all P ＜ 0.01).Moreover,the deduction in BNP was more dramatic in levosimendan group compared with control or milrinone group (t =3.256 or 2.665,P =0.004 or 0.026).After treatment for 5 days,the probability at least of achieving more effectively better improvement in NYHA class (cardiac function) in levosimendan group was 2.036 times that of control group (95％ CI:1.030-4.028,P =0.041).The incidence of combined end point events (death or readmission) in levosimendan group was significantly lower than that in milrinone group (50％ vs.70％,HR =0.573,95％ CI:0.358-0.917,P=0.020),while in hospital mortality,readmission or 3-month mortality incidence was similar among 3 groups (P ＞ 0.05).Conclusions The short-term clinical efficacy of levosimendan is superior to that of milrinone or conventional therapy in patients with decompensated heart failure.