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目的观察左西孟旦治疗失代偿心衰合并肾功能不全患者的疗效。方法回顾性分析本科2013年7月至2015年5月住院治疗的63例失代偿心衰患者(男性41例,女性22例),患者按肾功能损害程度分为2组:肾功能重度损害组(L1组)33例[GFR:15~<60 m L/(min·1.73 m~2)]和肾功能轻度损害组(L2组)30例[GFR:60~89 m L/(min·1.73 m~2)],输注左西孟旦治疗。比较、分析治疗后1、3、7、30 d患者N-末端脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-pro-BNP)、左心室射血分数(left ventricular ejection fraction,LVEF)、肾小球滤过率(glomerular filtration rate,GFR)的变化。结果 2组间治疗前除GFR外,其余基线指标差异无统计学意义(P>0.05);2组治疗后NT-pro-BNP 1、3、7 d较基线显著下降(P<0.05),LVEF 3、7 d较基线显著上升(P<0.05);2组间治疗前后NT-proBNP和LVEF差异无统计学意义(P>0.05);2组治疗后GFR 1、3、7 d较基线显著上升(P<0.05),其中L1组GFR 30 d仍较基线显著上升(P<0.05);L1组治疗后GFR改变量(△GFR)显著高于L2组(P<0.05)。结论失代偿心衰合并肾功能不全患者应用左西孟旦,能够改善心肾功能,对肾功能显著下降患者的肾功能改善幅度更大、持续时间更长。
Objective To observe the efficacy of levosimendan in patients with decompensated heart failure complicated with renal insufficiency. Methods Retrospective analysis of 63 cases of decompensated heart failure (41 males and 22 females) hospitalized from July 2013 to May 2015 were divided into two groups according to the degree of renal dysfunction: severe renal impairment (GFR: 15 ~ 60 m L / (min · 1.73 m ~ 2)] and mild renal impairment group (L2) [GFR: 60-89 m L / (min · 1.73 m ~ 2)], levosimendan infusion therapy. The levels of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), left ventricular ejection fraction fraction, LVEF), glomerular filtration rate (GFR). Results There was no significant difference in baseline parameters between the two groups before and after treatment (P> 0.05). The levels of NT-pro-BNP in the two groups after treatment were significantly lower than those at baseline on the 1st, 3rd and 7th days (P <0.05) (P <0.05). The difference of NT-proBNP and LVEF between the two groups had no significant difference before and after treatment (P> 0.05), and the GFR 1,3,7 d after treatment increased significantly from baseline (P <0.05). GFR in L1 group was still significantly higher than that in baseline at 30 days (P <0.05). GFR changes in group L1 were significantly higher than those in L2 group (P <0.05). Conclusion The application of levosimendan in patients with decompensated heart failure and renal insufficiency can improve the function of heart and kidney, improve the renal function in patients with significant decline in renal function, and last longer.