目的 探討左卡尼汀治療慢性腎衰血液透析患者心功能的臨床療效。方法 選取2010年10月—2014年6月中國(guó)人民解放軍第十一醫(yī)院收治的慢性腎衰血液透析合并心力衰竭患者274例,隨機(jī)分為對(duì)照組和治療組,每組137例。兩組患者均給予充分透析治療,治療組每次透析結(jié)束后5 min靜脈推注注射用左卡尼汀,1 g溶于生理鹽水10 mL。兩組均連續(xù)治療12周。觀察兩組患者的臨床療效,同時(shí)比較治療前后心功能系數(shù)、心功能結(jié)構(gòu)的變化。結(jié)果 對(duì)照組和治療組總有效率分別為69.34%、91.24%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P < 0.05)。治療后兩組患者心輸出量(CO)、心臟指數(shù)(CI)、每搏心輸出量(SV)、中心靜脈壓(CVP)、有效循環(huán)血量(ECV)、心肌耗氧量(MVO)、左室舒張末期容量(LDV)、左室舒張末期內(nèi)徑(LVIDd)、左室后壁厚度(LVPWT)、左室重量指數(shù)(LVMI)顯著下降,射血分?jǐn)?shù)(EF)、左室射血分?jǐn)?shù)(LVEF)、E/A顯著升高,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P < 0.05);且治療組這些觀察指標(biāo)的改善程度優(yōu)于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P < 0.05)。結(jié)論 左卡尼汀治療慢性腎衰血液透析心力衰竭患者具有較好的臨床療效,可改善患者的心功能和心臟結(jié)構(gòu),值得臨床廣泛推廣。

Objective To investigate the clinical effect of L-carnitine in improvement of cardiac function in chronic renal failure hemodialysis patients with heart failure. Methods The patients with chronic renal failure hemodialysis patients with heart failure (274 cases) of the Eleventh Hospital of Chinese People's Liberation Army from October 2010 to June 2014 were randomly divided into control and treatment groups, and each group had 137 cases. The patients in two groups were accepted adequate dialysis therapy. The patients in the treatment group were iv administered with L-carnitine for injection 5 min after dialysis (1 g diluted with 10 mL physiological saline). The patients in two groups were treated for 12 weeks. After treatment, the efficacy was evaluated, and the changes of cardiac function coefficients and structure were compared. Results The efficacies in the control and treatment groups were 69.34% and 91.24%, respectively, and there were differences between two groups (P < 0.05). After treatment, CO, CI, SV, CVP, ECV, MVO, LDV, LVIDd, LVPWT, and LVMI were significantly decreased, while EF, LVEF, and E/A were significantly increased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the indicators in the treatment group improved better than those in the control group, with the significant difference between two groups (P < 0.05). Conclusion L-carnitine has good clinical effect in treatment of chronic renal failure hemodialysis patients with heart failure, and can improve heart function and cardiac structure, which is worth clinical promotion.