【摘要】：目的:對(duì)比分析左西孟旦注射液與米力農(nóng)注射液治療頑固性心力衰竭臨床療效,并對(duì)二者安全性及預(yù)后進(jìn)行評(píng)價(jià)。方法:選取2014年9月至2015年9月于山東省單縣中心醫(yī)院住院的頑固性心力衰竭的住院患者80例,隨機(jī)分為左西孟旦組和米力農(nóng)組,每組40例。兩組均給予常規(guī)抗心力衰竭治療,包括吸氧、去除誘因、應(yīng)用利尿類(lèi)、血管緊張素轉(zhuǎn)換酶抑制劑或血管緊張素受體拮抗劑(ACEI類(lèi)或ARB)、β-受體阻滯劑、醛固酮受體拮抗劑、洋地黃類(lèi)、血管活性藥物、硝酸酯類(lèi)等常規(guī)藥物治療。隨后試驗(yàn)組給予左西孟旦注射液(悅文,山東齊魯制藥有限公司),先以12μg/Kg的負(fù)荷量靜脈注射(時(shí)間≥10分鐘),再以0.1ug/(kg.min)靜脈泵入,1小時(shí)后酌情減半或加倍持續(xù)靜脈泵入,共維持24小時(shí)。對(duì)照組給予米力農(nóng)注射液(魯南力康,魯南貝特制藥有限公司),先以50ug/kg的負(fù)荷量靜脈注射(時(shí)間≥10分鐘),之后酌情按照0.375-0.75ug/(kg.min)持續(xù)靜脈泵入,共維持24小時(shí)。用藥7天后,對(duì)比兩組呼吸困難改善癥狀及心功能分級(jí)有無(wú)好轉(zhuǎn);對(duì)比兩組氨基末端腦鈉肽前體(NT-pro BNP)水平、左心室射血分?jǐn)?shù)(LVEF)值、每搏輸出量(SV);記錄用藥期間不良反應(yīng);統(tǒng)計(jì)平均住院天數(shù),隨訪出院三個(gè)月內(nèi)再住院率及死亡率。結(jié)果:治療前兩組年齡、性別、高危因素、基礎(chǔ)疾病等一般基線資料的比較,數(shù)據(jù)差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。治療7天后:米力農(nóng)組的心功能改善及呼吸困難等癥狀緩解總有效率達(dá)72.5%,而左西孟旦組為92.5%,且左西孟旦組達(dá)到顯效的是米力農(nóng)組的1.7倍,兩組數(shù)據(jù)對(duì)比有統(tǒng)計(jì)學(xué)意義(P0.05);治療前兩組病人LVEF、SV及NT-pro BNP數(shù)據(jù)對(duì)比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),治療后兩組LVEF及SV均明顯上升,左西孟旦組升高差值優(yōu)于米力農(nóng)組,兩組數(shù)據(jù)比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);NT-pro BNP方面,左西孟旦組較米力農(nóng)組降低差值更加顯著,數(shù)據(jù)差異有統(tǒng)計(jì)學(xué)意義(P0.05)。左西孟旦組總的不良反應(yīng)發(fā)生率12.5%,低于米力農(nóng)組的22.5%,數(shù)據(jù)差異有統(tǒng)計(jì)學(xué)意義(P0.05)。左西孟旦組平均住院天數(shù)13.5±4.5天,較米力農(nóng)組16.5±6.5天短;預(yù)后方面,左西孟旦組三個(gè)月再入院率及死亡率較米力農(nóng)組低,數(shù)據(jù)差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1左西孟旦注射液治療頑固性心力衰竭臨床療優(yōu)于米力農(nóng)注射液,能夠更加顯著的緩解臨床癥狀及改善心功能分級(jí)。2左西孟旦與米力農(nóng)相比較,在提升頑固性心力衰竭的左室射血分?jǐn)?shù)(LVEF)、每搏心輸出量(SV)方面、降低氨基末端腦鈉肽前體(NT-Pro BNP)更有優(yōu)勢(shì)。3左西孟旦注射液安全性良好,平均住院天數(shù)相對(duì)較少,且有減少3個(gè)月死亡率、再住院率的趨勢(shì)。
[Abstract]:Objective: to evaluate the safety and prognosis of levosimendan injection and milrinone injection in the treatment of refractory heart failure. Methods: from September 2014 to September 2015, 80 patients with refractory heart failure in Shanxian Central Hospital of Shandong Province were randomly divided into two groups: levosimendan group and milrinone group with 40 cases in each group. Both groups were given routine anti-heart failure therapy, including oxygen inhalation, removal of inducement, diuretics, angiotensin converting enzyme inhibitors or angiotensin receptor antagonists (ACEI or ARB), 尾 -blockers, aldosterone receptor antagonists). Digitalis, vasoactive drugs, nitrates and other routine drug treatment. Then the experimental group was treated with levosimendan injection (Yuewen, Shandong Qilu Pharmaceutical Co., Ltd.), which was injected intravenously with a load of 12 渭 g/Kg (time 鈮，

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