目的 觀察間歇性使用左西孟旦治療難治性心力衰竭的臨床療效及安全性。方法 選取2014年1月-2015年12月首都醫(yī)科大學宣武醫(yī)院收治的難治性心力衰竭患者108例，按隨機數(shù)字表分為對照組、左西孟旦1周組和左西孟旦2周組，每組各36例。對照組患者給予抗心力衰竭基礎(chǔ)治療，包括血管擴張劑、利尿劑、醛固酮受體阻滯劑及血管緊張素轉(zhuǎn)換酶抑制劑、傳統(tǒng)正性肌力藥物洋地黃等。左西孟旦1周組在對照組基礎(chǔ)上于治療第1天給予左西孟旦注射液12 μg/kg，iv 10 min后改為靜脈滴注，速度為0.1 μg/（kg·min），滴注1 h后如果沒有出現(xiàn)嚴重低血壓，將滴注速度上調(diào)為0.2 μg/（kg·min），繼續(xù)滴注23 h。左西孟旦2周組在對照組基礎(chǔ)上于治療第1天及第8天給予左西孟旦注射液，具體用法同左西孟旦1周組。3組連續(xù)治療14 d。觀察3組的臨床療效，比較3組治療前后的心功能指標和血流動力學參數(shù)。結(jié)果 治療后，對照組、左西孟旦1周組及2周組的總有效率分別為55.6%、77.8%、94.4%，3組比較差異有統(tǒng)計學意義（P<0.05）；且左西孟旦2周組的總有效率優(yōu)于左西孟旦1周組，兩組比較差異有統(tǒng)計學意義（P<0.05）。治療后，3組患者的左心室射血分數(shù)（LVEF）均明顯升高，而收縮壓（SBP）、心率（HR）及N-末端前體腦鈉肽（NT-proBNP）均明顯降低，同組治療前后差異有統(tǒng)計學意義（P<0.05）；左西孟旦1周組及2周組這些觀察指標改善程度明顯優(yōu)于對照組（P<0.05）；且左西孟旦2周組這些觀察改善程度還明顯優(yōu)于左西孟旦1周組，兩組比較差異有統(tǒng)計學意義（P<0.05）。治療后，3組患者的心指數(shù)（CI）均明顯升高，而MPAP（平均肺動脈壓）、SVR（體循環(huán)阻力）、PCWP（肺毛細血管楔壓）均明顯降低，同組治療前后差異有統(tǒng)計學意義（P<0.05）；左西孟旦1周組及2周組這些觀察指標改善程度明顯優(yōu)于對照組（P<0.05）；且左西孟旦2周組這些觀察改善程度還明顯優(yōu)于左西孟旦1周組，兩組比較差異有統(tǒng)計學意義（P<0.05）。結(jié)論 間歇性使用左西孟旦治療難治性心力衰竭具有較好的臨床療效，能改善心臟功能和血流動力學，具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical effect of the intermittently administering with levosimendan in treatment of refractory heart failure. Methods Patients (108 cases) with refractory heart failure in Xuanwu Hospital Capital Medical University from January 2014 to December 2015 were divided into the control, levosimendan group for 1 week, and levosimendan group for 2 weeks, and each group had 36 cases. Patients in the control group were given the basic treatment of heart failure, including vascular expansion agent, diuretic, aldosterone receptor blockers and angiotensin converting enzyme inhibitors, traditional positive inotropic drugs such as digitalis. Patient in the levosimendan group for 1 week were iv administered with Levosimendan Injection on the basis of the control group at the first day of treatment, 12 μg/kg, iv for 10 min, and the method of administration were adjusted to intravenous drip of 0.1 μg/(kg·min) for 1 h, then drip rate were adjusted to 0.2 μg/(kg·min) for 23 h. Patients in the levosimendan group for 2 week were iv administered with Levosimendan Injection on the basis of the control group at the first and eighth day of treatment, and the method of administration was the same as levosimendan group for 1 week. Patients in three groups were treated for 14 d. After treatment, the clinical efficacies were evaluated, and heart function indexes and hemodynamic parameters in three groups were compared. Results After treatment, the clinical efficacies in the control, levosimendan group for 1 week, and levosimendan group for 2 weeks were 55.6%, 77.8% and 94.4%, respectively, and there was difference among three groups (P<0.05). And the clinical efficacy in the levosimendan group for 2 weeks was better than that in the levosimendan group for 1 week, with significant difference between two groups (P<0.05). After treatment, the LVEF in three groups were significantly increased, but SBP, HR and NT-proBNP in three groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the levosimendan group for 1 week and levosimendan group for 2 weeks were significantly better than those in the control group, with significant difference between two groups (P<0.05). And the observational indexes in the levosimendan group for 2 weeks was better than that in the levosimendan group for 1 week, with significant difference between two groups (P<0.05). After treatment, the CI in three groups was significantly increased, but MPAP, SVR, and PCWP in three groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the levosimendan group for 1 week and levosimendan group for 2 weeks were significantly better than those in the control group, with significant difference between two groups (P<0.05). And the observational indexes in the levosimendan group for 2 weeks was better than that in the levosimendan group for 1 week, with significant difference between two groups (P<0.05). Conclusion The intermittently administering with levosimendan has the clinical curative effect in treatment of refractory heart failure, and can improve heart function and hemodynamic function, which has a certain clinical application value.