左西孟旦在心力衰竭中应用.ppt

* * Levosimendan B bloker Lancet 2002; 360: 196–202 βblocker * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 3ml中左西孟旦含量为750微克为 * * 来自15个国家的30位专家，在复习和讨论了现有资料的基础上，对左西孟旦间断重复应用的患者、剂量和监测方法进行了推荐重复使用左西孟旦治疗慢性进展性心衰专家共识：临床证据、实践和展望 * * * Levosimendan in Daily Intensive Care Practice - the Experience of 15 Centres. The PORTLAND Study Introduction: In the LIDO and RUSSLAN trials, Levosimendan (LEVO) produced greater hemodynamic improvement than dobutamine, with no negative impact on prognosis. Our aim was to assess the efficacy and safety of LEVO when used in daily clinical practice for the treatment of decompensated heart failure. Methods: This is a prospective, multicentric, nonrandomized clinical trial with evaluations at baseline (BASAL), 24 hours (24H) and 5 days (5D) after the beginning of a 24h-infusion of LEVO. The setting was the intensive care units of 15 departments of cardiology or medicine. Results: We studied 129 patients (pts) with decompensated heart failure (HF). The etiology was ischemic in 48% of patients. Left ventricular ejection fraction was 0.24±0.07; 81% of pts were in NYHA class IV, 86% were on ACE inhibitors and 66% on intravenous Furosemide. Noninvasive monitoring was used in 61% of patients. During the first 24h, we observed a 2512±1107 ml diureses and a decrease in systolic blood pressure (SBP) (p=0.003). Compared to baseline, the following statistically significant changes (p<0.05) were observed at both 24H and at 5D: an improvement in NYHA class and in patient self-evaluation class, an increase in diureses, and a decrease in body weight, in pulmonary congestion and in serum creatinine level. Heart rate did not increase (p = 0.150 at 24H, p = 0.086 at 5D), nor did the incidence of angina, supraventricular arrhythmias or nonsustained ventricular tachycardias. At 24H, serum K (p _ 0.001) and haemoglobin levels (p _ 0.001) were lower than at baseline. Significant hypotension episodes (SBP _80 mmHg for _3 min) occurred in 27% of the pt