摘要目的:探讨不同剂量左西孟旦治疗32例高龄重症心力衰竭患者的疗效与安全性。方法:纳入32例≥75岁重症心力衰竭患者，采用随机数字表法将患者分为左西孟旦负荷剂量组（16例）和左西孟旦维持剂量组（16例），左西孟旦负荷剂量组患者在常规治疗的基础上先予左西孟旦负荷剂量6 μg/kg，随后以0.1 μg·kg -1·min -1维持至24 h；左西孟旦维持剂量组患者在常规治疗的基础上单予左西孟旦0.1 μg·kg -1·min -1维持24 h。检测2组患者治疗前后N末端B型利钠肽原（NT-proBNP）等水平。超声心动图检查2组患者治疗后左心室射血分数（LVEF）、每搏量（SV）、每搏量指数（SVI）等。记录2组患者不良反应、ICU住院时间及28 d病死率。 结果:与治疗前比，2组患者治疗后NT-proBNP[左西孟旦负荷剂量组：1 950（922,6 481）ng/L比4 018（2 716，9 637）ng/L；左西孟旦维持剂量组：1 390（599，3 297）ng/L比4 576（2 681，10 682）ng/L]、LVEF[左西孟旦负荷剂量组：（48.9±9.2）%比（39.4±8.8）%；左西孟旦维持剂量组：（48.7±12.0）%比（40.4±8.8）%]、SV[左西孟旦负荷剂量组：（57.9±10.3）ml比（48.9±11.0）ml；左西孟旦维持剂量组：（59.4±9.0）ml比（52.3±9.5）ml]均改善（ P<0.05）；左西孟旦负荷剂量组NT-proBNP在第3天开始较基线水平下降，而维持剂量组在第7天才开始下降；左西孟旦负荷剂量组第14天SVI较第1天升高[（29.4±6.5）ml/m 2比（27.3±6.7）ml/m 2， P<0.05]，而维持剂量组未升高。2组患者ICU住院时间[左西孟旦负荷剂量组（11.1±4.4）d比左西孟旦维持剂量组（9.6±3.5）d]、28 d病死率（左西孟旦负荷剂量组2/16比维持剂量组1/16）差异无统计学意义（ P>0.05）。左西孟旦负荷剂量组患者不良反应7例，维持剂量组2例，对症治疗后好转。 结论:对高龄重症心力衰竭患者，单纯维持剂量的左西孟旦能有效改善心功能，且安全。

abstractsObjective:To investigate the efficacy and safety of different dosage regimens of levosimendan in elderly patients with severe heart failure.Methods:Thirty-two patients 75 years or older were randomly divided into a loading dose group (16 cases) in which levosimendan was maintained at 0.1 μg·kg -1·min -1 for 24 h after loaded with 6 μg/kg, and a maintenance dose group (16 cases) with same schedule without loading dose. The amino-terminal brain natriuretic peptide (NT-proBNP) before and after treatment was detected. Left ventricular ejection fraction (LVEF), stroke volume (SV), stroke volume index (SVI) by echocardiograph were monitored. Adverse events, the length of stay in ICU and 28-day mortality were recorded. Results:The NT-proBNP level in loading group after treatment was 1 950 (922,6 481)ng/L, which was improved than that before treatment [4 018(2 716,9 637)ng/L, P<0.05]. The result was similar in maintenance group [1 390 (599,3 297)ng/L vs. 4 576 (2 681,10 682)ng/L, P<0.05]. LVEF in loading group before and after treatment was (39.4±8.8) % vs. (48.9±9.2) % respectively, while in maintenance group it was (40.4±8.8) % vs. (48.7±12.0) % (both P<0.05). SV were also improved after treatment in both groups compared with baseline levels ( P<0.05). NT-proBNP started to decline on day 3 in the loading group, while on day 7 in the maintenance group. SVI recovered on day 14 in the loading group [ (29.4±6.5) ml/m 2 vs. (27.3±6.7) ml/m 2, P<0.05], while it did not change much in the maintenance group. There was no significant differences as to the length of stay in ICU [ (11.1±4.4) d in loading group vs. (9.6±3.5) d in maintenance group] and 28-day mortality rates were comparable (2/16 in loading group vs. 1/16 in maintenance group) . The adverse events were 7 vs. 2 cases in loading group and maintenance group respectively, which were mild and all alleviated. Conclusion:The application of levosimendan only with maintenance dose improves cardiac function in very elderly patients with severe heart failure. Adverse events are mild and manageable.