左西孟旦与多巴酚丁胺对老年急性失代偿性心力衰竭患者心功能和血流动力学的影响

发布时间：2019-07-29 15:02

【摘要】：目的探讨左西孟旦与多巴酚丁胺对老年急性失代偿性心力衰竭(ADHF)患者心功能和血流动力学的影响。方法 81例ADHF患者采用随机数字表法分为左西孟旦组40例和多巴酚丁胺组41例;观察并比较两组治疗前1 d及治疗后1 d的血流动力学相关指标;观察并比较两组治疗3 d后6 min步行距离、24 h尿量、呼吸频率、心率的变化情况;观察治疗7 d后左室射血分数(LVEF)、左室舒张末期内径(LVEDD)变化情况及两组不良反应的发生情况。结果治疗后1 d,两组血流动力学指标均较治疗前明显下降(P0.05),且左西孟旦组周围血管阻力(SVR)、肺动脉平均压(PAMP)、肺毛细血管楔压(PCWP)均明显低于多巴酚丁胺组(P0.05)。治疗3 d后,两组6 min步行距离和24 h尿量都增加,而呼吸频率、心率都降低(P0.05);用药7 d后,两组LVEF增高(P0.05),而LVEDD无明显改变(P0.05);左西孟旦组6 min步行距离、24 h尿量、呼吸频率、心率及LVEF较多巴酚丁胺组改善更明显(P0.05);左西孟旦组不良反应发生率略低于多巴酚丁胺组,但差异无统计学意义(P0.05)。结论与多巴酚丁胺相比,左西孟旦治疗老年ADHF患者的临床效果更好,对患者心功能和血流动力学的改善效果更为明显,且安全性更高。
[Abstract]:Objective to investigate the effects of levosimendan and dobutamine on cardiac function and hemodynamics in elderly patients with acute decompensated heart failure (ADHF). Methods 81 patients with ADHF were randomly divided into left Simendan group (n = 40) and dobutamine group (n = 41). The hemodynamic parameters of the two groups were observed and compared before and 1 day after treatment, and the changes of 6 min walking distance, 24 h urine volume, respiratory frequency and heart rate were observed and compared between the two groups. The changes of left ventricular end-diastolic diameter (LVEDD) of left ventricular ejection fraction (LVEF),) and the occurrence of adverse reactions in the two groups were observed after 7 days of treatment. Results on the 1st day after treatment, the hemodynamic indexes in both groups were significantly lower than those before treatment (P 0.05), and the mean pulmonary artery pressure of (SVR), pulmonary artery in left Simendan group was significantly lower than that in dobutamine group (P 0.05). After 3 days of treatment, the 6 min walking distance and 24 h urine volume in both groups increased, while the respiratory frequency and heart rate decreased (P 0.05). After 7 days of treatment, LVEF increased (P 0.05), but LVEDD did not change significantly (P 0.05). The 6 min walking distance, 24 h urine volume, respiratory rate, heart rate and LVEF in the left Simendan group were more significantly improved than those in the dobutamine group (P 0.05), while the 6 min walking distance, 24 h urine volume, respiratory rate, heart rate and LVEF in the left Simendan group were significantly higher than those in the dobutamine group (P 0.05). The incidence of adverse reactions in levosimendan group was slightly lower than that in dobutamine group, but the difference was not statistically significant (P 0.05). Conclusion compared with dobutamine, levosimendan is more effective in the treatment of elderly patients with ADHF, has more obvious effect on cardiac function and hemodynamics, and is more safe.
【作者单位】：厦门大学附属第一医院重症医学科;福建省立医院干部特诊科;
【基金】：福建省自然科学基金项目(No.2014J01287)
【分类号】：R541.6

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