摘要
目的观察左西孟旦对并发右心衰竭的慢性血栓栓塞性肺动脉高压患者右心功能的改善作用及药物安全性。方法前瞻性选取2021年6月—2022年12月上海市肺科医院收治的54例慢性血栓栓塞性肺动脉高压并发右心衰竭患者,采用随机数字表法分为左西孟旦组(28例)和米力农组(26例)。2组患者在接受靶向药物和利尿等药物的基础上,分别加用左西孟旦或米力农。记录患者治疗前与治疗7 d后血压、心率、N末端B型利钠肽(NT-proBNP)等生物标志物,右心功能与结构等变化。结果左西孟旦治疗后患者NT-proBNP和总胆红素水平显著下降(P<0.05),动脉氧饱和度提高,超声心动图测得肺动脉收缩压、右房横径、右心室舒张末横径、三尖瓣环收缩期位移(TAPSE)和外侧三尖瓣环的收缩期峰值速度等参数均显著改善。与治疗前比较,米力农组治疗后TAPSE差异无统计学意义(P>0.05),左西孟旦组治疗后TAPSE则显著升高(P<0.05)。2种药物均可降低血压,但均未引起相关临床症状,且对肝肾功能均无明显影响(P>0.05)。结论左西孟旦能有效降低慢性血栓栓塞性肺动脉高压并发右心衰竭患者的NT-proBNP及胆红素水平,改善三尖瓣环收缩期位移,且安全性良好。
Objective To observe the effect and drug safety of levosimendan on improving the right heart function in patients with chronic thromboembolic pulmonary hypertension(CTEPH)complicated by right heart failure(RHF).Methods Fifty-four patients diagnosed with CTEPH and RHF,admitted to the Department of Pulmonary Circulation in Shanghai Pulmonary Hospital Affiliated to Tongji University from June 2021 to December 2022 were prospectively included and randomly divided into two groups:levosimendan group(n=28)and milrinone group(n=26).Both groups received standard treatment for CTEPH and heart failure,including pulmonary hypertension targeted drugs,diuretics,and so on.In addition,levosimendan was administered intravenously in levosimendan group;milrinone was administered in the milrinone group.Key parameters such as blood pressure,heart rate,and N-terminal B-type natriuretic peptide(NT-proBNP),and changes in right heart function and structure were recorded before and 7 days after treatment.Results After treatment,the levosimendan group showed significantly reductions in NT-proBNP levels and total bilirubin levels(P<0.05).Furthermore,improvements in arterial oxygen saturaion and echocardiographic parameters such as pulmonary artery systolic pressure,right atrial diameter,right ventricular end-diastolic diameter,tricuspid annular plane systolic excursion(TAPSE),and S'wave were observed.The increase in TAPSE after treatment was not significant in the milrinone group(P>0.05),while it was significantly elevated in the levosimendan group(P<0.05).Both drugs were associated with reductions in systemic blood pressure,but no clinical symptoms due to hypotension were observed,and there were no significant impacts on liver and kidney function(P>0.05).Conclusion Levosimendan effectively reduces NT-proBNP and bilirubin levels,improves TAPSE,and enhances right heart function in patients with CTEPH and RHF,and demonstrating good safety.
作者
徐杰
黄冬冬
赵慧
孟芳芳
徐本永
马强
赵勤华
吴文汇
XU Jie;HUANG Dongdong;ZHAO Hui;MENG Fangfang;XU Benyong;MA Qiang;ZHAO Qinhua;WU Wenhui(Department of Cardiology,Lianyungang Municipal Oriental Hospital,Lianyungang,Jiangsu 222042,China;不详)
出处
《中华全科医学》
2025年第12期2076-2079,2127,共5页
Chinese Journal of General Practice
基金
国家重点研发计划“常见病多发病防治研究”重点专项青年科学家项目(2023YFC2509500)
上海市科学技术委员会自然科学基金项目(22ZR1452400)
上海市浦江人才计划项目(22PJD064)
上海市卫生健康委员会卫生行业临床研究专项青年项目(20204Y0384)
上海市肺科医院临床研究项目(FKLY20005,fk18003)
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项目(2021LY0415)。
关键词
左西孟旦
慢性血栓栓塞性肺动脉高压
右心衰竭
Levosimendan
Chronic thromboembolic pulmonary hypertension
Right heart failure
