Comparison Of Clinical Efficacy Of Levosimendan Or Milrinone In Elderly Patients With Refractory Heart Failure

Objective:Heart Failure is a late manifestation of different causes of heart disease,especially in the elderly,and refractory heart failure is more difficult in cinical treatment.As the first calcium sensitizer recommended by the guideline,levosimendan is an important choice in the treatment of heart failure.Currently,there are relatively few domestic studies.To investigate the efficacy of levosimendan and Milrinone in elderly patients with refractory heart failure,to provide a theoretical and clinical basis for treatment of refractory heart failure.Methods:A total of 120 patients with refractory heart failure were selected from July 2016 to June 2017 in shouguang people’s hospital,Basic heart diseases included: ischemic cardiomyopathy,dilated cardiomyopathy,hypertensive heart failure,randomly assigned to the levosimendan group and the Milrinone group.Two groups of patients were carried out routine drug treatment,including cardiotonic drug,diuretic,angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor inhibitors,β adrenergic receptor blockers,and vascular expansion agent,etc.The experimental group was treated with levosimendan(yuewen,Qilu pharmaceutical co.,Ltd.),injections 12.5 mg in 5 %glucose injection 45 ml with intravenous infusion,levosimendan loading dose of 6 to 12μg /kg in the first 10 minutes and micro pump by 0.05-0.2 μg /(kg/min)and was kept for24 hours.Depending on the patient’s weight and tolerance,the dose may be slightly reduced or increased.The control group was treated with Milrinone injections 50μg /kg,was injected for 10 minutes,then 0.375 μg /(kg·min)was pumped in and lasted 72 hours.After 7 days,to observe general conditions,clinical curative effect,the BNP,echocardiography,adverse reactions and observing the prognosis.Results:There was no significant difference in the general data between the two groups before treatment(P>0.05).After 7 days of treatment: the total effective rate of levosimendan group was higher than that of milrinone group(P<0.05);The scores ofdyspnea and systemic symptoms in the two groups improved after treatment,and the effect of levosimendan group was better than that of milrinone group(P<0.05);The levels of BNP,SV and LVEF were significantly different between the two groups before and after treatment(P<0.05),and the level of BNP in levosimendan group was significantly lower than that of milrinone group after treatment(P<0.05);the levels of SV and LVEF in levosimendan group was higher than that of milrinone group(P<0.05);During the hospitalization,there was no significant difference in adverse reactions between the two groups(P>0.05);The mean hospitalization days of patients in levosimendan were significantly shorter than those in milrinone(P<0.05);The rehospitalization rate was significantly lower in group of levosimendan than that of milrinone,and there was no significant difference between the two groups during the follow-up period(P>0.05).Conclusions:The therapeutic effect of levosimendan on elderly intractable heart failure is significant.It can significantly improve the clinical symptoms,reduce the level of BNP,improve the level of SV and LVEF,reduce the incidence of adverse reactions,and have a low rate of rehospitalization for 3 months,and the effect is obviously superior to milrinone,which is worthy of clinical practice.