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间断重复应用左西孟旦治疗肺动脉高压右心衰竭的临床观察
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| 篇名： | 间断重复应用左西孟旦治疗肺动脉高压右心衰竭的临床观察 |
| TITLE： | Clinical observation of intermittently repeated application of levosimendan in the treatment of right heart failure of pulmonary hypertension |
| 摘要： | 目的 观察间断重复应用左西孟旦治疗肺动脉高压右心衰竭的疗效和安全性。方法选择2019年1月－2021年5月在广西医科大学第一附属医院住院治疗的70例肺动脉高压右心衰竭患者，按随机数字表法分为对照组和观察组，每组各35例。对照组中肺动脉高压危险分层为中危的患者给予他达拉非片和安立生坦片，高危患者给予他达拉非片、安立生坦片和曲前列尼尔注射液，同时均给予抗右心衰竭药物；观察组患者在对照组治疗的基础上静脉泵入左西孟旦注射液12.5mg，每月1次，泵入速度为0.05～0.1μg（/kg·min），共3个月。观察两组患者治疗有效率，治疗后肺动脉高压危险分层改善情况，治疗前后肺动脉平均压、6min步行距离（6MWD）、血清NT-proBNP水平、右心房压（RAP）、混合静脉血氧饱和度（SvO2）、心指数（CI）、右心室射血分数（RVEF）、三尖瓣环舒张早期血流峰速度/三尖瓣环舒张早期运动峰速度（E/Ea）、三尖瓣环收缩期位移（TAPSE）、右心室舒张末期内径（RVEDD）、右心室收缩末期内径（RVESD）以及不良反应发生情况。结果治疗后，观察组患者的治疗有效率显著高于对照组（P＜0.05）；两组患者的肺动脉平均压、NT-proBNP水平、RAP、E/Ea、RVEDD、RVESD均显著低于同组治疗前，6MWD、SvO2、CI、TAPSE、RVEF均显著高于同组治疗前，且观察组患者的NT-proBNP水平、E/Ea均显著低于对照组，6MWD、CI、TAPSE、RVEF均显著高于对照组（P＜0.05或P＜0.01）；而两组患者的肺动脉平均压、肺动脉高压危险分层改善例数、RAP、SvO2、RVEDD、RVESD、无症状低血压发生率比较，差异均无统计学意义（P＞0.05）。结论间断重复应用左西孟旦可以改善肺动脉高压右心衰竭患者的右心功能，且安全性较好。 |
| ABSTRACT： | OBJECTIVE To observe th e efficacy and safety of intermittently repeated application of levosimendan in the treatment of right heart failure of pulmonary hypertension. METHODS A total of 70 cases of right heart failure of pulmonary hypertension were collected from the First Affiliated Hospital of Guangxi Medical University during Jan. 2019-May 2021，and then randomly divided into control group and observation group ，with 35 cases in each group.In control group ，the patients with moderate risk of classification of pulmonary hypertension were given Tadalafil tablets and Ambrisentan tablets ，while the patients with high risk were given Tadalafil tablets ，Ambrisentan tablets and Treprostinil injection ；both were given anti-right heart failure drugs at the same time. On the basis of treatment in the control group ，patients in the observation group were additionally intravenously pumped with levosimendan injection 12.5 mg，once a month ，at a rate of 0.05-0.1 μg/（kg·min），3 months in total. Response rate of therapy ，improvement of risk stratification of pulmonary hypertension after treatment ，and average pulmonary artery pressure ，six-minute walk distance （6MWD），serum level of N-terminal pro brain natriuretic peptide （NT-proBNP），right atrial pressure （RAP），oxygen saturation in mixed venous blood （SvO2），cardiac index （CI），right ventricular ejection fraction （RVEF），early diastolic tricuspid inflow velocity/early diastolic tricuspid annular velocity （E/Ea），tricuspid annular plane systolic excursion（TAPSE），right ventricular end-diastolic diameter （RVEDD），right ventricular end-systolic diameter （RVESD）before and after treatment ，and the occurrence of adverse reactions were observed in 2 groups. RESULTS The total response rate of observation group was significantly higher than control group after treatment （P＜0.05）. After treatment ，average pulmonary artery pressure，NT-proBNP level ，RAP，E/Ea，RVEDD and RVESD of 2 groups were significantly lower than before treatment ，while 6MWD，SvO2， CI， TAPSE and RVEF were significantly higher than before treatment ；NT-proBNP level and E/Ea of observation group were significantly lower than control group ， while 6MWD，CI，TAPSE and RVEF were significantly higher than control group （P＜0.05 or P＜0.01）. There was no significant difference in average pulmonary artery pressure ， risk stratification improvement cases of pulmonary hypertension ， RAP， SvO2， RVEDD， RVESD and the incidence of asymptomatic hypotension between 2 groups（P＞0.05）. CONCLUSIONS Intermittently repeated application of levosimendan can improve the function of right heart of pulmonary hypertension complicated with right heart failure and has good safety. |
| 期刊： | 2022年第33卷第14期 |
| 作者： | 韦斌，张朝勇，邓燕，钟诗颖，韦哲，黄凯 |
| AUTHORS： | WEI Bin，ZHANG Chaoyong ，DENG Yan，ZHONG Shiying ，WEI Zhe，HUANG Kai |
| 关键字： | 左西孟旦；右心衰竭；肺动脉高压；强心剂；间断重复；疗效；安全性 |
| KEYWORDS： | levosimendan；right heart failure ；pulmonary hypertension ；inotropic agent ；intermittently repeated ；efficacy；safety |
| 阅读数： | 284 次 |
| 本月下载数： | 6 次 |
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