摘要
目的观察心脏移植等待患者间断重复输注左西孟旦治疗心力衰竭的临床疗效。方法选取2019年6月至2021年1月间首都医科大学附属北京安贞医院37例心脏移植等待患者,接受每月一次输注左西孟旦策略,每次剂量为12.5 mg,输注速度为0.1 ml·kg^(-1)·min^(-1),时限6个月。研究终点为心衰发作需机械辅助、需紧急心脏移植及死亡。收集基线与终点数据资料,血红蛋白、B型利钠肽(BNP)、N末端B型利钠肽前体(NT-proBNP)、肝功能、肾功能检验,行心电图、心脏超声心动图检查和6分钟步行试验,完成明尼苏达心力衰竭生活质量评分和堪萨斯心肌病评分。结果1例患者于研究起始3月后在院外猝死;3例患者分别于研究起始1、2、4月后在院内因心力衰竭死亡;7例患者在研究观察期间接受了队列计划的心脏移植。研究前后,患者的血红蛋白、肝功能、肾功能指标数据没有显著性差异;超声心动图测得的左心室舒张末内径分别为(73.3±8.0)mm和(71.7±8.7)mm,差异无显著性;射血分数分别为(21.3±3.7)%和(23.3±5.5)%,差异无显著性;BNP水平显著下降,分别为(2857.0±1003.5)pg/ml和(2205.3±1120.5)pg/ml;但NT-proBNP无显著差异,分别为(3605.3±1254.7)pg/ml和(3325.3±1537.0)pg/ml;6分钟步行试验结果增加,分别为(255±95)m和(294±86)m,差异具有显著性;研究前后,明尼苏达心力衰竭评分与堪萨斯心肌病评分分别为(37±18)、(45±20),(45±23)、(49±22),差异无显著性。结论间断重复输注左西孟旦治疗终末期心力衰竭心脏移植等待患者,改善了BNP水平和6分钟步行试验结果;在治疗过程中其安全性可接受。
Objective To observe the clinical effect of intermittent and repetitive use of levosimendan in patients in the waiting list of heart transplantation.Methods Thirty-seven patients were given infusions of Levosimendan with a dose of 12.5 mg,at a speed of 0.1 ml·kg^(-1)·min^(-1),once a month,within 6 months.The endpoint was defined as needing mechanic device support and needing emergency heart transplantation or death.The baseline and end-point data of hemoglobin,renal function,hepatic function,echocardiography,BNP,NT-proBNP,6 minutes walk distance(6MWD),Minnesota Living with Heart Failure Questionnaire(MLHFQ)and Kansas city cardiomyopathy questionnaire(KCCQ)were collected and compared.Results Sudden death occured in one case and the other 3 cases died of heart failure 1,2 and 4 months after beginning of the study,respectively.Heart transplantation through waiting list were performed in 7 cases.Compared to the baseline,the endpoint data of the hemoglobin,creatine,GFR,total bilirubin and direct bilirubin showed no apparently difference.LVEDD decreased from(73.3±8.0)mm to(71.7±8.7)mm,with difference statistically non-significant and the ejection fraction increased with the value of(21.3±3.7)%vs.(23.3±5.5)%,with on-significant;BNP decreased with difference statistically significant[(2857.0±1003.5)pg/ml vs.(2205.3±1120.5)pg/ml]yet NT-proBNP decreased with difference statistically non-significant[(3605.3±1254.7)pg/ml vs.(3325.3±1537.0)pg/ml];6MWD increased from(255±95)m to(294±86)m,with difference statistically significant.MLHFQ and KSSQ improved with no significant difference[(37±18)vs.(45±20),(45±23)vs.(49±22)respectively].Conclusion The strategy of intermittent and repetitive use of levosimendan in patients in the waiting list of heart transplantation could improve the BNP level and 6MWD with safety in the administration.
作者
秦英
贾一新
孟旭
李岩
焦玉清
韩薇
韩杰
刘彤
QIN Ying;JIA Yi-xin;MENG Xu;LI Yan;JIAO Yu-qing;HAN wei;HAN Jie;LIU Tong(Pharmaceutical division,eijing Anzhen Hospital Affiliated to Capital Medcial University,100029 Beijing,China;Cardiac Surgery Department,eijing Anzhen Hospital Affiliated to Capital Medcial University,100029 Beijing,China;Cardiology Department,Beijing Anzhen Hospital Affiliated to Capital Medcial University,100029 Beijing,China)
出处
《中国心血管病研究》
CAS
2021年第8期740-744,共5页
Chinese Journal of Cardiovascular Research
基金
中华国际医学交流基金会心血管多学科整合思维研究基金支持项目(z-2016-23-2101-26)。
关键词
左西孟旦
重复输注
心脏移植
Levosimendan
Repetitive infusion
Heart transplatation
