左旋西孟旦
多巴酚丁胺
医学
血流动力学
肺楔压
临床终点
心力衰竭
麻醉
内科学
心输出量
心脏病学
随机对照试验
作者
Ferenc Folláth,John G.F. Cleland,Hanjörg Just,Papp Jg,Hasso Scholz,Keijo Peuhkurinen,Veli‐Pekka Harjola,Veselin Mitrović,Mona Abdalla,Esa-Pekka Sandell,Lasse Lehtonen
出处
期刊:The Lancet
[Elsevier]
日期:2002-07-01
卷期号:360 (9328): 196-202
被引量:1071
标识
DOI:10.1016/s0140-6736(02)09455-2
摘要
Levosimendan, a novel calcium sensitiser, improves myocardial contractility without causing an increase in myocardial oxygen demand. We compared the effects of levosimendan and dobutamine on haemodynamic performance and clinical outcome in patients with low-output heart failure.Patients were recruited into a multicentre, randomised, double-blind, double-dummy, parallel-group trial. Under continuous haemodynamic monitoring, an initial loading dose of levosimendan of 24 microg/kg was infused over 10 min, followed by a continuous infusion of 0.1 microg kg(-1) min(-1) for 24 h. Dobutamine was infused for 24 h at an initial dose of 5 microg kg(-1) min(-1) without a loading dose. The infusion rate was doubled if the response was inadequate at 2h. The primary endpoint was the proportion of patients with haemodynamic improvement (defined as an increase of 30% or more in cardiac output and a decrease of 25% or more in pulmonary-capillary wedge pressure) at 24 h. Analyses were by intention to treat.103 patients were assigned levosimendan and 100 dobutamine. The primary haemodynamic endpoint was achieved in 29 (28%) levosimendan-group patients and 15 (15%) in the dobutamine group (hazard ratio 1.9 [95% CI 1.1-3.3]; p=0.022). At 180 days, 27 (26%) levosimendan-group patients had died, compared with 38 (38%) in the dobutamine group (0.57 [0.34-0.95]; p=0.029).In patients with severe, low-output heart failure, levosimendan improved haemodynamic performance more effectively than dobutamine. This benefit was accompanied by lower mortality in the levosimendan group than in the dobutamine group for up to 180 days.
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