| 摘要: |
| ［摘要］ 目的 分析重症超声评估左西孟旦治疗急性失代偿性心力衰竭（ADHF）患者的疗效。方法 回顾性分析2020年9月至2021年12月广西壮族自治区人民医院心血管内科收治的156例ADHF患者的临床资料。根据住院期间是否使用左西孟旦将患者分为左西孟旦组（74例）和对照组（82例）。比较两组治疗前后血浆N末端B型利钠肽前体（NT-proBNP）、左室舒张末期内径（LVEDD）、左房前后径（LAD）、左心室射血分数（LVEF）以及肺部超声B线数量的变化。比较两组院内死亡率，出院1个月内、6个月内全因死亡率以及出院6个月内因心力衰竭（HF）再入院率。采用多因素Cox回归分析左西孟旦使用情况、肺部超声B线数量与主要终点事件发生的关系。结果 与治疗前比较，两组治疗后NT-proBNP下降、LVEF提高、肺部超声B线数量减少，左西孟旦组治疗后LVEDD缩小，差异有统计学意义（P<0.05）。治疗后，左西孟旦组的NT-proBNP下降程度、肺部超声B线数量减少程度显著大于对照组（P<0.05）。左西孟旦组出院6个月内因HF再入院率显著低于对照组（P<0.05）。多因素Cox回归分析结果显示，左西孟旦组出院6个月内因HF再入院风险显著低于对照组（P<0.05），肺部超声B线数量≥3条可增加患者出院6个月内因HF再入院风险（P<0.05）。结论 在常规治疗基础上联用左西孟旦可更显著改善ADHF患者心功能，减轻肺淤血，并降低出院6个月内因HF再入院率，且不增加短期全因死亡率和全因死亡风险。重症超声评估为ADHF治疗决策与预后判断提供了重要客观依据，值得临床推广。 |
| 关键词: 急性失代偿性心力衰竭 左西孟旦 重症超声 疗效 |
| DOI：10.3969/j.issn.1674-3806.2026.07.05 |
| 分类号:R 541.6 |
| 基金项目:国家自然科学基金项目（编号：82260060）；广西自然科学基金项目（编号：2025GXNSFAA069114）；心血管多学科整合思维研究基金项目（编号：z-2016-23-2101-49） |
|
| Analysis on the efficacy of levosimendan in treatment of patients with acute decompensated heart failure assessed by using critical care ultrasound |
|
Lin Jing1, Ji Qingwei1, Liu Ling1, Shi Ying1, Huang Zongyan1, Shen Jie2, Yang Fan3
|
|
1.Department of Cardiology, Research Center for Cardiovascular Diseases, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China; 2.Department of Ultrasound Medicine, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China; 3.Department of Cardiology, Liuzhou Worker′s Hospital, Liuzhou 545005, China
|
| Abstract: |
| ［Abstract］ Objective To analyze the efficacy of levosimendan in treatment of patients with acute decompensated heart failure(ADHF) assessed by using critical care ultrasound. Methods A retrospective analysis was conducted on the clinical data of 156 patients with ADHF who were admitted to the Department of Cardiology of the People′s Hospital of Guangxi Zhuang Autonomous Region from September 2020 to December 2021. According to whether the patients received levosimendan treatment during hospitalization, they were divided into levosimendan group(74 patients) and control group(82 patients). The changes in plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP), left ventricular end-diastolic diameter(LVEDD), left atrial diameter(LAD), left ventricular ejection fraction(LVEF), and lung ultrasound B-line counts before and after the treatment were compared between the two groups. The in-hospital mortality rate, all-cause mortality rates within 1 month and within 6 months after discharge, and readmission rate due to heart failure(HF) within 6 months after discharge were compared between the two groups. Multivariate Cox regression was used to analyze the relationship of levosimendan treatment and lung ultrasound B-line counts with primary endpoint events. Results Compared with those before treatment, NT-proBNP decreased, and LVEF increased, and lung ultrasound B-line counts decreased in both groups after treatment, and LVEDD in the levosimendan group decreased after treatment, with statistically significant differences(P<0.05). After treatment, the degree of decrease in NT-proBNP and the degree of decrease in lung ultrasound B-line counts in the levosimendan group were significantly greater than those in the control group(P<0.05). The readmission rate due to HF within 6 months after discharge in the levosimendan group was significantly lower than that in the control group(P<0.05). The results of multivariate Cox regression analysis showed that the risk of readmission due to HF within 6 months after discharge in the levosimendan group was significantly lower than that in the control group(P<0.05), and the lung ultrasound B-line counts ≥3 could increase the risk of readmission due to HF within 6 months after discharge(P<0.05). Conclusion The combination of conventional treatment and levosimendan can more significantly improve the cardiac function of ADHF patients, reduce pulmonary congestion, and lower the readmission rate due to HF within 6 months after discharge, without increasing short-term all-cause mortality and the risk of all-cause mortality. Critical care ultrasound assessment can provide important objective basis for the treatment decision-making and prognostic judgment in ADHF, and is worthy of clinical promotion. |
| Key words: acute decompensated heart failure(ADHF) levosimendan critical care ultrasound efficacy |
