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目的探讨左西孟旦、米力农以及多巴酚丁胺治疗急性失代偿心力衰竭患者的临床疗效及安全性。方法收取2013年4月—2016年4月间西安市中心医院收治的急性失代偿心力衰竭患者336例作为研究对象,根据入院先后顺序依次进入A、B、C组,每组各112例,分别给予左西孟旦、米力农和多巴酚丁胺进行治疗。对3组患者临床疗效、血流动力学、血清学指标以及安全性进行观察与比较。结果 A组总有效率(90.18%)明显高于B组(58.93%)及C组(65.18%),差异有统计学意义(P<0.05)。治疗后3组患者肺毛细血管楔压(PCWP)、肺动脉平均压(PAMP)、右房压(RAP)及周围血管阻力(SVR)均较治疗前显著下降,差异有统计学意义(P<0.05),A组PCWP、PAMP及SVR明显低于B组及C组(P<0.05)。3组治疗后RAP差异不显著。治疗后3组患者氨基末端B型利钠肽原(NT-pro BNP)、内皮素-1(ET-1)以及去甲肾上腺素(NE)水平均较治疗前明显下降(P<0.05);A组显著低于B组及C组(P<0.05)。A组不良反应发生率明显低于B组及C组,差异有统计学意义(P<0.05)。结论左西孟旦治疗急性失代偿心力衰竭疗效及安全性均显著优于米力农及多巴酚丁胺,值得临床推广应用。
Objective To investigate the clinical efficacy and safety of levosimendan, milrinone and dobutamine in patients with acute decompensated heart failure. Methods A total of 336 patients with acute decompensated heart failure who were admitted to Xi’an Central Hospital from April 2013 to April 2016 were enrolled in this study. The patients admitted to groups A, B and C were divided into two groups according to the sequence of hospital admission: Were given levosimendan, milrinone and dobutamine for treatment. Clinical efficacy, hemodynamics, serological indicators and safety of the three groups were observed and compared. Results The total effective rate (90.18%) in group A was significantly higher than that in group B (58.93%) and group C (65.18%). The difference was statistically significant (P <0.05). The PCWP, PAMP, RAP and SVR in the three groups after treatment were significantly lower than those before treatment (P <0.05) ), PCWP, PAMP and SVR in group A were significantly lower than those in group B and C (P <0.05). There was no significant difference in RAP between the three groups after treatment. After treatment, the levels of NT-pro BNP, ET-1 and NE in three groups were significantly lower than those before treatment (P <0.05); A group was significantly lower than B group and C group (P <0.05). A group of adverse reactions was significantly lower than the B group and C group, the difference was statistically significant (P <0.05). Conclusion The efficacy and safety of levosimendan in the treatment of acute decompensated heart failure are significantly superior to milrinone and dobutamine, which is worthy of clinical application.