摘要
目的:评估左西孟旦治疗重症肺动脉高压合并右心衰竭患者的疗效和安全性。方法:连续入组2018年3月至2020年12月期间入住我中心的重症肺动脉高压合并右心衰竭患者103例,平均年龄(35.62±12.29)岁,男性40例(39%)。给予患者静脉泵入左西孟旦,起始剂量0.05μg/(kg·min),根据患者血压情况逐渐加量至0.2μg/(kg·min),持续泵入24 h。比较患者用药前、后的临床症状、体重、心率、血压、N末端B型利钠肽原(NT-proBNP)、心功能等指标的变化情况。结果:103例患者中,特发性肺动脉高压41例、先天性心脏病相关性肺动脉高压20例、结缔组织疾病相关性肺动脉高压2例、肺静脉闭塞病2例和慢性血栓栓塞性肺动脉高压38例。WHO功能分级Ⅲ级68例、Ⅳ级35例。与用药前相比,用药后患者收缩压降低[(112.19±15.57)mm Hg(1 mmHg=0.133 kPa)vs.(101.52±23.69)mmHg,P=0.043],舒张压无明显变化(P>0.05);心率明显下降[(86.8±15.0)次/min vs.(79.3±12.8)次/min,P<0.001];NT-pro BNP明显下降[(2219.27±1227.98)pg/ml vs.(1192.05±848.15)pg/ml,P<0.001];血尿酸明显降低[(517.55±135.78)μmol/L vs.(438.55±112.85)μmol/L,P<0.001],用药前、后丙氨酸氨基转移酶、总胆红素、血肌酐浓度差异无统计学意义(P均>0.05)。2例患者用药后发作心房颤动,1例患者用药后发作快速心房扑动,停止用药后逐渐缓解。结论:左西孟旦治疗可降低重症肺动脉高压合并右心衰竭患者的NT-proBNP水平,降低心率和血尿酸水平,用药后收缩压稍下降舒张压无明显变化,具有一定的安全性和耐受性。
Objectives: To evaluate the efficacy and safety of levosimendan for the treatment of patients with severe pulmonary hypertension and right heart failure.Methods: From March 2018 to December 2020, patients with severe pulmonary hypertension and right heart failure were screened in our center. Levosimendan was initiated with a rate of 0.05 μg/(kg·min) in eligible patients, then adjusted to 0.2 μg/(kg·min) according to the blood pressure of patients, and was maintained for 24 h. Body weight, heart rate, blood pressure, NT-proBNP, cardiac function and echocardiography and cardiopulmonary exercise test and blood gas analysis before and after treatment were compared.Results: A total of 103 patients with a mean age of(35.62±12.29) years were enrolled, of which 40(39%) were males.There were 41 cases of idiopathic pulmonary arterial hypertension, 20 cases of pulmonary arterial hypertension associated with congenital heart disease, 2 cases of pulmonary arterial hypertension associated with connective tissue disease, 2cases of pulmonary veno-occlusive disease, and 38 cases of chronic thromboembolic pulmonary hypertension. WHO functional class III was found in 68 patients and IV in 35 patients. After administration, heart rate significantly decreased from(86.8±15.0) beats/min to(79.3±12.8) beats/min(P<0.001). After treatment, the systolic blood pressure decreased([112.19±15.57] mmHg vs. [101.52±23.69] mmHg, P=0.043) NT-proBNP was significantly decreased([2 219.27±1 227.98]pg/ml vs. [1 192.05±848.15] pg/ml, P<0.001), so were uric acid([517.55±135.78] μmol/L vs. [438.55±112.85] μmol/L,P<0.001). Alanine aminotransferase, total bilirubin and serum creatinine concentrations remained unchanged. Among them, 2 patient experienced new-onset atrial fibrillation, 1 patient developed rapid atrial flutter, which gradually eased after stopping the medication.Conclusions: Levosimendan could reduce the levels of NT-proBNP and heart rate and uric acid in patients with severe pulmonary hypertension and right heart failure, the systolic blood pressure decreased slightly and the diastolic blood pressure is not affected post medication, indicating a relatively safe and tolerable profile of levosimendan use in these patients.
作者
晏露
赵智慧
赵青
熊长明
邓丽
罗勤
柳志红
YAN Lu;ZHAO Zhihui;ZHAO Qing(Pulmonary Vascular Diseases Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第3期239-242,共4页
Chinese Circulation Journal
关键词
肺动脉高压
右心衰竭
左西孟旦
pulmonary hypertension
right heart failure
levosimendan
