CAJ | 학술논문

目的：评价老年慢性心力衰竭（ CHF）患者应用左西孟旦治疗的效果及安全性。方法选取2012年9月—2013年12月于河北医科大学第二医院心血管内科住院治疗的老年CHF患者50例，采用随机数字表法将其分为对照组（26例）和左西孟旦组（24例）。两组患者均进行常规基础治疗，左西孟旦组在此基础上采用左西孟旦注射液，初始10 min给予负荷量12μg/kg静脉注射，继而以0.1μg · kg-1· min-1微量泵入，1 h后将输注速率增至0.2μg · kg-1·min-1持续23 h，5 d后以同样方法给予第2次治疗。观察两组用药前及用药后10 d血B型脑钠肽（ BNP）、左心室射血分数（ LⅤEF）、每搏心输出量（ SⅤ）、呼吸困难情况、全身状况评估、6分钟步行试验；用药后10 d纽约心脏病协会（ NYHA）分级显效率；3个月内再住院率及病死率；监测用药前30 min及用药后1、12、24 h呼吸频率、心率、血压等生命体征；用药前及用药后24 h、10 d血红蛋白（ Hb）、血肌酐（ Scr）、血钾值；观察不良反应发生情况。结果用药前，两组BNP、LⅤEF、SⅤ、呼吸困难情况、全身状况评估和6分钟步行试验比较，差异均无统计学意义（P>0.05）；用药后10 d，左西孟旦组BNP、呼吸困难情况和全身状况评估均低于对照组；LⅤEF、SⅤ和6分钟步行试验均高于对照组（P<0.05）。左西孟旦组NYHA显效率高于对照组（χ2=5.265，P=0.022）。用药期间左西孟旦组不良反应发生率为12.5%（3/24），对照组为3.8%（1/26）。用药3个月内，对照组再住院率为23.1%（6/26）、病死率为11.5%（3/26），左西孟旦组分别为8.3%（2/24）、8.3%（2/24）。两组再住院率和病死率比较，差异均无统计学意义（χ2=2.018、0.142，P=0.155、0.706）。两组用药前后HR、R、SBP、DBP、Scr、血钾和Hb时间与组间的交互作用均无统计学意义（P>0.05）；两组HR、R、血钾组间比较差异有统计学意义（P<0.05）。结论左西孟旦注射液治疗老年CHF疗效显著，可有效改善患者心功能分级，增加LⅤEF，且不增加再住院率和病死率，但有增加低血钾的趋势。目的：評價老年慢性心力衰竭（ CHF）患者應用左西孟旦治療的效果及安全性。方法選取2012年9月—2013年12月于河北醫科大學第二醫院心血管內科住院治療的老年CHF患者50例，採用隨機數字錶法將其分為對照組（26例）和左西孟旦組（24例）。兩組患者均進行常規基礎治療，左西孟旦組在此基礎上採用左西孟旦註射液，初始10 min給予負荷量12μg/kg靜脈註射，繼而以0.1μg · kg-1· min-1微量泵入，1 h後將輸註速率增至0.2μg · kg-1·min-1持續23 h，5 d後以同樣方法給予第2次治療。觀察兩組用藥前及用藥後10 d血B型腦鈉肽（ BNP）、左心室射血分數（ LⅤEF）、每搏心輸齣量（ SⅤ）、呼吸睏難情況、全身狀況評估、6分鐘步行試驗；用藥後10 d紐約心髒病協會（ NYHA）分級顯效率；3箇月內再住院率及病死率；鑑測用藥前30 min及用藥後1、12、24 h呼吸頻率、心率、血壓等生命體徵；用藥前及用藥後24 h、10 d血紅蛋白（ Hb）、血肌酐（ Scr）、血鉀值；觀察不良反應髮生情況。結果用藥前，兩組BNP、LⅤEF、SⅤ、呼吸睏難情況、全身狀況評估和6分鐘步行試驗比較，差異均無統計學意義（P>0.05）；用藥後10 d，左西孟旦組BNP、呼吸睏難情況和全身狀況評估均低于對照組；LⅤEF、SⅤ和6分鐘步行試驗均高于對照組（P<0.05）。左西孟旦組NYHA顯效率高于對照組（χ2=5.265，P=0.022）。用藥期間左西孟旦組不良反應髮生率為12.5%（3/24），對照組為3.8%（1/26）。用藥3箇月內，對照組再住院率為23.1%（6/26）、病死率為11.5%（3/26），左西孟旦組分彆為8.3%（2/24）、8.3%（2/24）。兩組再住院率和病死率比較，差異均無統計學意義（χ2=2.018、0.142，P=0.155、0.706）。兩組用藥前後HR、R、SBP、DBP、Scr、血鉀和Hb時間與組間的交互作用均無統計學意義（P>0.05）；兩組HR、R、血鉀組間比較差異有統計學意義（P<0.05）。結論左西孟旦註射液治療老年CHF療效顯著，可有效改善患者心功能分級，增加LⅤEF，且不增加再住院率和病死率，但有增加低血鉀的趨勢。
목적：평개노년만성심력쇠갈（ CHF）환자응용좌서맹단치료적효과급안전성。방법선취2012년9월—2013년12월우하북의과대학제이의원심혈관내과주원치료적노년CHF환자50례，채용수궤수자표법장기분위대조조（26례）화좌서맹단조（24례）。량조환자균진행상규기출치료，좌서맹단조재차기출상채용좌서맹단주사액，초시10 min급여부하량12μg/kg정맥주사，계이이0.1μg · kg-1· min-1미량빙입，1 h후장수주속솔증지0.2μg · kg-1·min-1지속23 h，5 d후이동양방법급여제2차치료。관찰량조용약전급용약후10 d혈B형뇌납태（ BNP）、좌심실사혈분수（ LⅤEF）、매박심수출량（ SⅤ）、호흡곤난정황、전신상황평고、6분종보행시험；용약후10 d뉴약심장병협회（ NYHA）분급현효솔；3개월내재주원솔급병사솔；감측용약전30 min급용약후1、12、24 h호흡빈솔、심솔、혈압등생명체정；용약전급용약후24 h、10 d혈홍단백（ Hb）、혈기항（ Scr）、혈갑치；관찰불량반응발생정황。결과용약전，량조BNP、LⅤEF、SⅤ、호흡곤난정황、전신상황평고화6분종보행시험비교，차이균무통계학의의（P>0.05）；용약후10 d，좌서맹단조BNP、호흡곤난정황화전신상황평고균저우대조조；LⅤEF、SⅤ화6분종보행시험균고우대조조（P<0.05）。좌서맹단조NYHA현효솔고우대조조（χ2=5.265，P=0.022）。용약기간좌서맹단조불량반응발생솔위12.5%（3/24），대조조위3.8%（1/26）。용약3개월내，대조조재주원솔위23.1%（6/26）、병사솔위11.5%（3/26），좌서맹단조분별위8.3%（2/24）、8.3%（2/24）。량조재주원솔화병사솔비교，차이균무통계학의의（χ2=2.018、0.142，P=0.155、0.706）。량조용약전후HR、R、SBP、DBP、Scr、혈갑화Hb시간여조간적교호작용균무통계학의의（P>0.05）；량조HR、R、혈갑조간비교차이유통계학의의（P<0.05）。결론좌서맹단주사액치료노년CHF료효현저，가유효개선환자심공능분급，증가LⅤEF，차불증가재주원솔화병사솔，단유증가저혈갑적추세。
Objective To evaluate the efficacy and safety of levosimendan in the treatment of elderly patients with chronic heart failure( CHF). Methods We enrolled 50 elderly patients with CHF who received hospitalized treatment in the Department of Cardiology of the Second Hospital of Hebei medical University from September 2012 to December 2013. By random number table method,the subjects were divided into two groups:control group(n=26)and levosimendan group(n=24). The two groups were both administrated with conventional basic treatment. The levosimendan group was also given levosimendan, with intravenous injection by 12 μg/kg for the first 10 minutes and micro pump by 0. 1 μg · kg-1 · min-1 after that;one hour after the injection began,the infusion rate was increased to 0. 2 μg·kg-1 ·min-1 and was kept for 23 hours. Five days after the injection began,the second round of the same therapy was given to the subjects in the levosimendan group. We observed BNP, LⅤEF,SⅤ,dyspnea,systemic condition,6-minute walk test results before intervention and on day 10 after intervention;we recorded the proportion of patients with higher NYHA grade after intervention;we recorded readmission rate and mortality within three months after intervention;we monitored respiratory rate,heart rate,blood pressure and other vital signs 30 minutes before intervention and at 1 h,12 h and 24 h after intervention;we recorded Hb,Scr and K before intervention,at 24 h and on day 10 after intervention;adverse reaction was also observed. Results Before the intervention,the two groups were not significantly different(P> 0. 05) in BNP,LⅤEF,SⅤ,dyspnea,systemic condition,6 - minute walk test results;on day 10 after intervention,the levosimendan group was lower(P<0. 05)in BNP,dyspnea and systemic condition and higher(P<0. 05) in LⅤEF,SⅤ and 6-minute walk test results than the control group;the levosimendan group had higher NYHA effective rate than the control group(χ2 =5. 265,P=0. 022). During the intervention,the rate of adverse reaction was 12. 5%(3/24) in the levosimendan group and 3. 8%(1/26) in the control group. Within three months after intervention,the readmission rate and the mortality were 23. 1%(6/26)and 11. 5%(3/26)for the control group and 8. 3%(2/24)and 8. 3%(2/24)for the levosimendan group. The two groups were not significantly different in readmission rate and mortality(χ2 =2. 018,0. 142;P=0. 155,0. 706). No significant interaction effect(P>0. 05)was noted between the two groups in HR,R,SBP,DBP,Scr, K and Hb before intervention and after intervention;the two groups were significantly different(P<0. 05)in HR,R and K. Conclusion Levosimendan injection is significantly effective in the treatment of elderly patients with CHF. It can effectively improve the cardiac functional grading of patients and increase LⅤEF without increase in readmission rate and mortality,while it may increase the incidence of hypokalemia.