| Objective:To observe the effect of levosimendan and recombinant human brain natriuretic peptide in the treatment of senile patients with acute onset of chronic heart failure and the change of plasma concentration of GDF-15.Methods: From February 2018 to February 2019,80 elderly patients with acute exacerbation of chronic heart failure(NYHA Class IV)were hospitalized in Qingdao Municipal Hospital.The basic cardiac diseases of the patients included coronary atherosclerotic heart disease,hypertensive heart disease and dilated cardiomyopathy.They were randomly and double-blind divided into Simdax group and recombinant human brain natriuretic peptide group.There were 26 males and 14 females in the Simdax group(with an average age of 76.13±6.12)years old;In the recombinant human brain natriuretic peptide group,there were 17 males and23 females(with an average age of 75.33±6.10 years old.)There were 27 patients with coronary heart disease,6 patients with hypertensive heart disease and 7 patient with dilated cardiomyopathy in the Simdax group.The recombinant human brain natriuretic peptide group includes 30 patients with coronary heart disease,4 patients with hypertensive heart disease and 6 patients with dilated cardiomyopathy.Both groups were treated with conventional drugs(diuretic,nitrate,cardiac tonic,ACEI/ARB,aldosterone receptor antagonist,and Beta receptor blocker).Simdax was continuously pumped for 24 hours in Simdax group,and recombinant human brain natriuretic peptide was continuously intravenously pumped for 24 hours in recombinant human brain natriuretic peptide group.After 7 days of medication,the basic vital signs,cardiac function classification,NT-Pro BNP,stroke volume,left ventricular ejection fraction,adverse reactions,readmission rate and mortality rate of patients within 1 month after follow-up and discharge were collected and observed.Results: After 7 days of treatment,the total effective rate of Simdax group was 82.5%)was less than the total effective rate of recombinant human brain natriuretic peptide group(85%),and the difference was not statistically significant(P > 0.05);Urine volume,blood lactic acid concentration,NT-Pro BNP,GDF-15,SV and LVEF levels in each group changed significantly(P < 0.05)24 hours after treatment,and 24 hours urine volume in Simdax group(1041.73±253.53)was lower than that of rh BNP group(1388.25±308.23)had statistical difference(P < 0.05);Blood lactic acid concentration in Simdax group after treatment(1.95± 0.58)was lower than rh BNP group(2.91 ± 1.27)had statistical difference(p < 0.05)NT-Pro BNP level in Simdax group after treatment(2174.94±304.69)significantly higher than rh BNP group(1761).The difference was statistically significant(P < 0.05).GDF-15 level in Simdax group(1824.07±357.19)was significantly lower than that of rh BNP group(2421.37 ±546.00)respectively,with statistical difference(P < 0.05);SV and LVEF levels in Simdax group(81.68 ±2.91;40.63±3.89)were higher than those in rh BNP group(74.10 ±1.08;38.25 ±3.02).The difference was statistically significant(P < 0.05).However,there was no significant difference in liver enzyme and serum creatinine levels between the two groups before and after treatment(P > 0.05)? The adverse reactions were observed.In the Simdax group,there were 3 cases of headache,1 case of hypotension and 1 case of hypokalemia.In rh-BNP group,headache occurred in 2 cases,hypotension in 5 cases,nausea in 1 case and hypokalemia in 2 cases.Incidence of adverse reactions in Simdax group(12.5%)was lower than that of rh-BNP group(25%).The average hospital stay in Simdax group was(13.18±2.30)days,the average hospitalization days in rh-BNP group(16.43 ±2.78)days,the difference was statistically significant(P < 0.05).There were 4 readmitted patients and 1death in Simdax group and 9 readmitted patients and 1 death in rh-BNP group within one month.The readmission rate in Simdax group was lower than that in rh-BNP group,and the difference was statistically significant(P < 0.05).One died in each group during the follow-up period.Conclusion: Basic anti-heart failure drugs combined with Simdax and rh BNP are effective in treating heart failure,which can reduce heart rhythm and blood pressure,improve respiration and relieve systemic circulation congestion.Simdax has obvious advantages over rh BNP in improving cardiac output,increasing left ventricular ejection fraction,reducing blood lactic acid level,and reducing cardiac function classification.rh BNP has advantages over Simdax in to increase urine output,improving circulation volume load,and reducing NT-Pro BNP.The average hospitalization days of patients treated by Simdax and the readmission rate of patients followed up for one month are lower than those of rh BNP.The incidence of adverse reactions in patients treated with Simdax is lower than that of rh BNP.No serious and difficult-to-correct adverse reactions are found in both groups and the safety is good. |
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