Wang Y B, Yu Y H, Gong S J, Yan J, Wang Y
Department of Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China.
Zhonghua Nei Ke Za Zhi. 2020 Jun 1;59(6):433-438. doi: 10.3760/cma.j.cn112138-20190827-00587.
To investigate the efficacy and safety of different dosage regimens of levosimendan in elderly patients with severe heart failure. Thirty-two patients 75 years or older were randomly divided into a loading dose group (16 cases) in which levosimendan was maintained at 0.1 μg·kg(-1)·min(-1) for 24 h after loaded with 6 μg/kg, and a maintenance dose group (16 cases) with same schedule without loading dose. The amino-terminal brain natriuretic peptide (NT-proBNP) before and after treatment was detected. Left ventricular ejection fraction (LVEF), stroke volume (SV), stroke volume index (SVI) by echocardiograph were monitored. Adverse events, the length of stay in ICU and 28-day mortality were recorded. The NT-proBNP level in loading group after treatment was 1 950 (922,6 481)ng/L, which was improved than that before treatment [4 018(2 716,9 637)ng/L, <0.05]. The result was similar in maintenance group [1 390 (599,3 297)ng/L vs. 4 576 (2 681,10 682)ng/L, <0.05]. LVEF in loading group before and after treatment was (39.4±8.8) % vs. (48.9±9.2) % respectively, while in maintenance group it was (40.4±8.8) % vs. (48.7±12.0) % (both <0.05). SV were also improved after treatment in both groups compared with baseline levels (<0.05). NT-proBNP started to decline on day 3 in the loading group, while on day 7 in the maintenance group. SVI recovered on day 14 in the loading group [ (29.4±6.5) ml/m(2) vs. (27.3±6.7) ml/m(2),<0.05], while it did not change much in the maintenance group. There was no significant differences as to the length of stay in ICU [ (11.1±4.4) d in loading group vs. (9.6±3.5) d in maintenance group] and 28-day mortality rates were comparable (2/16 in loading group vs. 1/16 in maintenance group) . The adverse events were 7 vs. 2 cases in loading group and maintenance group respectively, which were mild and all alleviated. The application of levosimendan only with maintenance dose improves cardiac function in very elderly patients with severe heart failure. Adverse events are mild and manageable.
探讨不同剂量方案的左西孟旦治疗老年重度心力衰竭患者的疗效及安全性。将32例75岁及以上患者随机分为负荷剂量组（16例），先静脉注射6 μg/kg，随后以0.1 μg·kg⁻¹·min⁻¹持续静脉输注24小时；和维持剂量组（16例），不给予负荷剂量，直接按照相同的维持剂量方案给药。检测治疗前后的氨基末端脑钠肽前体（NT-proBNP）水平。采用超声心动图监测左心室射血分数（LVEF）、每搏输出量（SV）、每搏输出量指数（SVI）。记录不良事件、入住重症监护病房（ICU）的时间及28天死亡率。负荷剂量组治疗后NT-proBNP水平为1950（922，6481）ng/L，较治疗前[4018（2716，9637）ng/L]有所改善，差异有统计学意义（P<0.05）。维持剂量组结果相似[1390（599，3297）ng/L对4576（2681，10682）ng/L，P<0.05]。负荷剂量组治疗前后LVEF分别为（39.4±8.8）%和（48.9±9.2）%，维持剂量组为（40.4±8.8）%和（48.7±12.0）%，两组差异均有统计学意义（P均<0.05）。两组治疗后SV较基线水平均有所改善（P<0.05）。负荷剂量组NT-proBNP在第3天开始下降，维持剂量组在第7天开始下降。负荷剂量组SVI在第14天恢复[（29.4±6.5）ml/m²对（27.3±6.7）ml/m²，P<0.05]，维持剂量组变化不大。两组入住ICU时间差异无统计学意义[负荷剂量组（11.1±4.4）天对维持剂量组（9.6±3.5）天]，28天死亡率相当（负荷剂量组2/16，维持剂量组1/16）。负荷剂量组和维持剂量组不良事件分别为7例和2例，均较轻微且均已缓解。仅采用维持剂量的左西孟旦治疗可改善高龄重度心力衰竭患者的心功能。不良事件轻微且可控。
