Page 100 - 《中国药房》2022年14期

·药物与临床·

间断重复应用左西孟旦治疗肺动脉高压右心衰竭的临床观察 Δ

韦 斌 ，张朝勇 ，邓 燕 ，钟诗颖 ，韦 哲 ，黄 凯 （1.广西医科大学第一附属医院心脏重症监护室，南宁
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530021；2.广西医科大学第一附属医院超声科，南宁 530021）
中图分类号 R972 .1；R543.2 文献标志码 A 文章编号 1001-0408（2022）14-1754-05
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DOI 10.6039/j.issn.1001-0408.2022.14.16
摘 要 目的 观察间断重复应用左西孟旦治疗肺动脉高压右心衰竭的疗效和安全性。方法 选择2019年1月－2021年5月在广
西医科大学第一附属医院住院治疗的70例肺动脉高压右心衰竭患者，按随机数字表法分为对照组和观察组，每组各35例。对照
组中肺动脉高压危险分层为中危的患者给予他达拉非片和安立生坦片，高危患者给予他达拉非片、安立生坦片和曲前列尼尔
注射液，同时均给予抗右心衰竭药物；观察组患者在对照组治疗的基础上静脉泵入左西孟旦注射液 12.5 mg，每月 1 次，泵入速
度为 0.05～0.1 μg/（kg·min），共3个月。观察两组患者治疗有效率，治疗后肺动脉高压危险分层改善情况，治疗前后肺动脉平均
压、6 min步行距离（6MWD）、血清NT-proBNP水平、右心房压（RAP）、混合静脉血氧饱和度（SvO2 ）、心指数（CI）、右心室射血分数
（RVEF）、三尖瓣环舒张早期血流峰速度/三尖瓣环舒张早期运动峰速度（E/Ea）、三尖瓣环收缩期位移（TAPSE）、右心室舒张末期
内径（RVEDD）、右心室收缩末期内径（RVESD）以及不良反应发生情况。结果 治疗后，观察组患者的治疗有效率显著高于对照组
（P＜0.05）；两组患者的肺动脉平均压、NT-proBNP 水平、RAP、E/Ea、RVEDD、RVESD 均显著低于同组治疗前，6MWD、SvO2、CI、
TAPSE、RVEF均显著高于同组治疗前，且观察组患者的NT-proBNP水平、E/Ea均显著低于对照组，6MWD、CI、TAPSE、RVEF均显
著高于对照组（P＜0.05或P＜0.01）；而两组患者的肺动脉平均压、肺动脉高压危险分层改善例数、RAP、SvO2、RVEDD、RVESD、无
症状低血压发生率比较，差异均无统计学意义（P＞0.05）。结论 间断重复应用左西孟旦可以改善肺动脉高压右心衰竭患者的右
心功能，且安全性较好。
关键词 左西孟旦；右心衰竭；肺动脉高压；强心剂；间断重复；疗效；安全性
Clinical observation of intermittently repeated application of levosimendan in the treatment of right heart
failure of pulmonary hypertension
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WEI Bin ，ZHANG Chaoyong ，DENG Yan ，ZHONG Shiying ，WEI Zhe ，HUANG Kai（1. Cardiac Intensive
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Care Unit，the First Affiliated Hospital of Guangxi Medical University，Nanning 530021，China；2. Dept. of
Ultrasound，the First Affiliated Hospital of Guangxi Medical University，Nanning 530021，China）
ABSTRACT OBJECTIVE To observe the efficacy and safety of intermittently repeated application of levosimendan in the
treatment of right heart failure of pulmonary hypertension. METHODS A total of 70 cases of right heart failure of pulmonary
hypertension were collected from the First Affiliated Hospital of Guangxi Medical University during Jan. 2019-May 2021，and then
randomly divided into control group and observation group，with 35 cases in each group.In control group，the patients with
moderate risk of classification of pulmonary hypertension were given Tadalafil tablets and Ambrisentan tablets，while the patients
with high risk were given Tadalafil tablets，Ambrisentan tablets and Treprostinil injection；both were given anti-right heart failure
drugs at the same time. On the basis of treatment in the control group，patients in the observation group were additionally
intravenously pumped with levosimendan injection 12.5 mg，once a month，at a rate of 0.05-0.1 μg/（kg·min），3 months in total.
Response rate of therapy，improvement of risk stratification of pulmonary hypertension after treatment，and average pulmonary
artery pressure，six-minute walk distance（6MWD），serum level of N-terminal pro brain natriuretic peptide（NT-proBNP），right
atrial pressure（RAP），oxygen saturation in mixed venous blood（SvO2 ），cardiac index（CI），right ventricular ejection fraction
（RVEF），early diastolic tricuspid inflow velocity/early diastolic tricuspid annular velocity（E/Ea），tricuspid annular plane systolic
excursion（TAPSE），right ventricular end-diastolic diameter（RVEDD），right ventricular end-systolic diameter（RVESD）before
and after treatment，and the occurrence of adverse reactions were observed in 2 groups. RESULTS The total response rate of
observation group was significantly higher than control group after treatment（P＜0.05）. After treatment，average pulmonary artery
pressure，NT-proBNP level，RAP，E/Ea，RVEDD and RVESD of 2 groups were significantly lower than before treatment，while
6MWD，SvO2， CI， TAPSE and RVEF were significantly
Δ 基金项目 国家自然科学基金资助项目（No.82060051）；广西壮
higher than before treatment；NT-proBNP level and E/Ea of
族自治区卫生健康委员会自筹经费科研项目（No.Z20191081）
observation group were significantly lower than control group，
＊第一作者 副主任医师，博士。研究方向：先天性心脏病和肺动
while 6MWD，CI，TAPSE and RVEF were significantly higher
脉高压临床与基础。E-mail：wb_yessenia@163.com
# 通信作者 主任医师，硕士。研究方向：先天性心脏病、肺动脉高 than control group （P＜0.05 or P＜0.01）. There was no
压和心血管危重症临床与基础。E-mail：drhk98@163.com significant difference in average pulmonary artery pressure，

·1754 · China Pharmacy 2022 Vol. 33 No. 14 中国药房 2022年第33卷第14期