Levosimendan And Dobutamine Comparative Research In Refractory Heart Failure

ObjectiveEvaluation of Levosimendan (Levosimendan) and dobutamine treatment of intractableheart failure (RHF refractory heart failure,) clinical curative effect and adverse reactions.Aimed to explore of levosimendan in patients with refractory heart failure treatment effectand its mechanism of action.MethodsSelect70cases of in patients with refractory heart failure, follow the principle ofrandomized, open, controlled, and randomly divided into treatment group (35cases) andcontrol group B, group A group (35cases). Foundation treatment is the same in bothgroups, the treatment group given leosimendan treatment, control group given dobutaminetreatment. Two groups of patients’ age, sex, blood pressure, heart rate, cardiac functionindexes had no statistical difference. Treatment observation time is7days. Observed twogroups of patients’ vital signs before and after the treatment, degree of difficulty inbreathing and blood biochemical indicators of change; Determination of two groups beforeand after treatment plasma Brain natriuretic peptide (Brain natriuretic peptide, BNP),Determine the Cardiac index before and after treatment (Cardiac index, CI), Stroke volume,(SV), Left ventricular ejection fraction,(LVEF) and other indicators; tumor necrosis factor(TNFalpha) and matrix metalloproteinase1(MMP-1); Observe two groups of seriousadverse events (arrhythmia and myocardial ischemia). To test the test data with statisticalsoftware support SPSS11.5, P <0.05think difference is statistically significant.Results1. The general observation indexes:Breathing difficulties improve curative effect analysis: breathing difficulty score aftertreatment group A plus or minus0.99to1.16from2.380.58mm, compared before andafter treatment was statistically difference (P <0.05). Group B after treatment breathingdifficulty rating by2.24±1.09to1.65±0.74, comparing differences between before and after treatment was statistically significant (P <0.05). Before the treatment, comparingdifferences between the two groups (P>0.05). After treatment, degree of dyspneaimproved in group A than group B was statistically difference (P <0.05).2. Ultrasonic cardiogram measuring LVEF, SV, CILVEF improved curative effect analysis: before and after treatment group A averageLVEF respectively34%,49%, difference have statistical significance before and aftermedication; Average group B before and after treatment were34%,41%respectively, thedifference was statistically significant before and after medication; After treatment groupA was significantly better than group B (P <0.05).SV to improve the curative effect of analysis: before and after treatment group A SVaverage46ml,62ml, respectively, before and after medication was statistically significantdifference; Group B before and after treatment the average47ml,52ml, respectivelybefore and after medication was statistically significant difference; After treatment groupA was significantly better than group B (P <0.05).CI to improve the curative effect of analysis: before and after treatment group A CIaverage3.1L/min/m2,3.6L/min/m2, the difference was statistically significant before andafter medication; Average group B before and after treatment were3.2L/min/m2,3.4L/min/m2, the difference was statistically significant before and after medication; Aftertreatment group A was significantly better than group B (P <0.05).3.The BNP concentrationAfter treatment group A blood BNP levels by12319pg/ml to1154pg/ml, comparedbefore and after treatment was statistically difference (P <0.05). Group B after treatmentthe BNP levels by12135pg/ml to1675pg/ml, compared before and after treatment wasstatistically significant difference (P <0.05). Before the treatment, the level differencebetween the two groups (P>0.05). After treatment, two groups have statistical difference(P <0.05).4.TNF alpha and MMP1levelGroup B before and after treatment TNF alpha-and the level of MMP1had nosignificant change (P>0.05). After treatment group A TNF alpha and MMP1level havesignificantly decreased, compared with before treatment was statistically significantdifference (P <0.05); Compared with group B (P <0.05).5.Creatinine concentrationGroup B after treatment serum creatinine level from198umol/L fell to152umol/L.Compared before and after treatment was statistically difference (P <0.05). Serum creatinine level after treatment group A umol/L fell to122from180umol/L. Comparedbefore and after treatment was statistically significant difference (P <0.05). Before thetreatment, the serum creatinine level differences between the two groups (P>0.05). Aftertreatment, two groups of serum creatinine was statistically difference (P <0.05).6.The two groups after treatment there was no significant difference between thenumber of adverse events.Conclusion:1. The curative effect is levosimendan injection in treatment of refractory left heartfailure, can obviously alleviate the symptoms of shortness of breath;2.this study proves that levosimendan than dobutamine improved significantly theLVEF in patients with refractory heart failure;3.the study found that leosimendan was statistically significant decrease of serumbrain natriuretic peptide (BNP) clinical effect;4.the treatment group compared with control group, the levosimendan cansignificantly improve cardiac index (CI);5.evidence of this study show that levosimendan can further improvement of leftventricular systolic function in patients with refractory heart failure;6. levosimendan in myocardial apoptosis resistance, anti-inflammatory, immuneregulation and improvement of nerve in the body hormonal abnormalities such as a varietyof mechanisms, shows that compared with other traditional the superiority of the positiveinotropic drugs.