| ObjectiveAim to observe the effects of levosimendan and dobutamine on cardiac function,MACE events and adverse drug reactions in elderly patients with acute heart failure before and after treatment.MethodsThe elderly patients with acute heart failure who were hospitalized in emergency department of Xuanwu Hospital of Capital Medical University from Janunary 2016 to February 2017 were divided into levosimendan treatment group and dobutamine treatment group.Single center,controlled clinical study.Patients with acute heart failure were treated with conventional treatment,on the basis of the need to use more than levosimendan or dobutamine treatment.Levosimendan was continuous pumping24 hours in 0.1ug/kg/min to 0.2ug/kg/min.Dobutamine was continous pumping 72 hours in 3ug/kg/min-10ug/kg/min.Observed everybody’s vital sign,clinical symptom,dected urine volume,NT-pro BNP,routine blood test,blood biochemistry,et al,before and after 24 hours,72 hours,7 days of treatment.In addition,all the patients began using the cardiac color Doppler ultrasound at baseline and 7 days to check the structure and function of the heart,by the fixed physician operation.SPSS software was used to compare the data of the two groups by statistical methods.ResultsA total of 95 cases were selected,and there were a total of 58 cases in the levosimendan group,the age of the patients was about 70.33 years old;the age of the patients in the dobutamine group(n = 37)was about 71.57 years.1.Before treatment,there was no difference between the two groups in age,gender,height,weight,history of hypertension,diabetes,smoking and drinking history,heart rate,blood pressure,urine volume,serum creatinine,NT-pro,BNP,cardiac function(P>0.05).2.There was no significant difference between the two groups in the etiology of heart failure,P>0.05(P=0.973);coronary heart disease(CHD)accounted for the first place in the heart failure of the patients in the two groups.3.Levosimendan group,after treatment,diastolic pressure in patients with 24 h decreased slightly compared with before treatment,P<0.05(P=0.035)was statistically significant.After the treatment of 7d patients with systolic blood pressure decreased slightly than before treatment,P<0.05(P=0.012),there was significant difference.4.The levels of serum NT-pro BNP in24 h,72h and 7d decreased after treatment with levosimendan,and had statistical significance compared with before treatment(P<0.05).The serum levels of NT-pro BNP 72 h after treatment were statistically significant(P=0.035)compared with that of 24 h after treatment.The levels of serum NT-pro BNP in 24 h and 72 h after treatment with levosimendan were not statistically significant compared with those of7 d after treatment(P=0.116,P=0.166).The levels of serum NT-pro BNP in 24 h,72h and 7d increased slightly after treatment in dobutamine group,but the levels of serum NT-pro BNP were not significantly different between the two groups(P>0.05).5.Two groups of patients after treatment 7d examination of heart color Doppler ultrasound,left levosimendan group before treatment LVEF and SV were 42.11 +7.74,68.89 + 20.20,after treatment 46.30 + 10.75,78.69 + 20.48,higher than before,there was statistical significance(P<0.01).Dobutamine group before treatment LVEF and SV were 45.60 + 4.01,66.66 + 20,46.28 + 9.78 and 67.86 + 19.42 after treatment,slightly higher than before treatment,but P>0.005,no statistical significance.There was no statistical difference in LVIDd between the two groups before and after treatment,P>0.05.In the levosimendan group,there was a statistically significantdifference between 7d and CI before treatment,P<0.05,whereas there was no significant difference between dobutamine group and P>0.05 group.The SV in the levosimendan group increased by 8.81 ml,and in the dobutamine group,the 7d of SV increased by 1.31 ml compared with that before treatment,compared the two groups,P<0.01.6.In the two groups,the incidence of MACE events in the levosimendan group was lower than that in the amikacin group.7.Levosimendan had hypotension events,but the incidence of malignant arrhythmias was significantly lower than that of dobutamine.Conclusions1.Compare with dobutamine,levosimendan can obviously improve the heart fuction of elderly patients with acute heart failure after treatment,improve left ventricular ejection fraction,stroke volume and cardiac index.2.The serum NT-pro BNP level showed a downward trend,and the serum NT-pro BNP improved most obviously after treatment in the patients with 72 h.3.The use of levosimendan occurred MACE event is lower than dobutamine.4.Levosimendan had adverse events,but the incidence of malignant arrhythmia was significantly lower than dobutamine. |
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