Zhang Yu-hui, Qing En-ming, Zhang Jian, Huang Yan, Lü Rong, Zhou Qiong, Wei Bing-qi, An Tao, Qing Ping, Zou Chang-hong
Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Yi Xue Za Zhi. 2012 Feb 28;92(8):555-8.
To compare the hemodynamic effects of domestic levosimendan versus dobutamine on patients with acute decompensated heart failure (ADHF).
A total of 78 ADHF patients with pulmonary capillary wedge pressure (PCWP) ≥ 15 mm Hg and cardiac index (CI) ≤ 2.5 L×min(-1)×m(-2) were enrolled into this blind, positive-controlled, randomized and multicenter study to receive 24 h intravenous levosimendan or dobutamine therapy. They were randomized into 2 groups: levosimendan and dobutamine (n = 39 each).
In the levosimendan group, the PCWP 24 h decreased significantly ((14.2 ± 7.6) vs (23.1 ± 8.1) mm Hg, P < 0.01)and CI increased significantly versus the baseline levels ((2.8 ± 0.7) L×min(-1)×m(-2) vs (2.0 ± 0.4) L×min(-1)×m(-2), P < 0.01). As compared with the dobutamine group, the change percentages versus baseline in PCWP, pulmonary arterial mean pressure (PAMP), systemic vascular resistance (SVR) at 24 h (median) decreased or increased significantly in the levosimendan group 45.5% vs 22.1% (P < 0.05); 20.8% vs 15.0% (P < 0.05); 34.5% vs 12.7% (P < 0.01); CI increased 39.8% vs 13.5% (P < 0.01). As compared with the baseline level, LVEF increased at 24 h in the levosimendan group (27.4% ± 6.1% vs 32.5% ± 8.7%, P < 0.05). Both PCWP and CI at 24 h correlated significantly with NT-proBNP at Day 3 (r = 0.31, P < 0.01; r = -0.29, P < 0.05). Dyspnea improved greatly at 24 h in the levosimendan group than that in the dobutamine group.
As compared with dobutamine, domestic levosimendan may bring about better outcomes of hemodynamics and dyspnea.
比较国产左西孟旦与多巴酚丁胺对急性失代偿性心力衰竭（ADHF）患者的血流动力学影响。
本项盲法、阳性对照、随机、多中心研究共纳入78例肺毛细血管楔压（PCWP）≥15 mmHg且心脏指数（CI）≤2.5 L×min⁻¹×m⁻²的ADHF患者，接受24小时静脉注射左西孟旦或多巴酚丁胺治疗。他们被随机分为2组：左西孟旦组和多巴酚丁胺组（每组n = 39）。
左西孟旦组24小时时PCWP显著降低（（14.2±7.6） vs （23.1±8.1）mmHg，P < 0.01），CI较基线水平显著升高（（2.8±0.7）L×min⁻¹×m⁻² vs （2.0±0.4）L×min⁻¹×m⁻²，P < 0.01）。与多巴酚丁胺组相比，左西孟旦组24小时（中位数）时PCWP、肺动脉平均压（PAMP）、全身血管阻力（SVR）相对于基线的变化百分比显著降低或升高，分别为45.5% vs 22.1%（P < 0.05）；20.8% vs 15.0%（P < 0.05）；34.5% vs 12.7%（P < 0.01）；CI升高39.8% vs 13.5%（P < 0.01）。与基线水平相比，左西孟旦组24小时时左心室射血分数（LVEF）升高（27.4%±6.1% vs 32.5%±8.7%，P < 0.05）。24小时时的PCWP和CI均与第3天的N末端脑钠肽前体（NT-proBNP）显著相关（r = 0.31，P < 0.01；r = -0.29，P < 0.05）。左西孟旦组24小时时呼吸困难改善程度大于多巴酚丁胺组。
与多巴酚丁胺相比，国产左西孟旦可能带来更好的血流动力学和呼吸困难改善效果。
