Abstract: Background　Many positively inotropic agents are used clinically，but their application scopes may be restricted due to increased treatment-related incidence rate of arrhythmia and case fatality rate.Clinical application and research of levosimendan，a new positively inotropic agent，for the treatment of right ventricular （RV） failure are relatively few.Objective　To investigate the effects of Levosimendan on RV function in patients with acutely decompensated heart failure （ADHF）．Methods　This was a single-center randomized controlled trial.A total of 79 cases of ADHF from the Second Hospital of Hebei Medical University were enrolled during January 2017 to January 2018，and were randomly divided into Levosimendan group （n=40） and control group （n=39）．Besides standardized treatment，Levosimendan group received Levosimendan as a 10-min intravenous bolus infusion at 6–12 μg/kg，followed by a continuous 24-h infusion at 0.1 μg•kg-1•min-1，and control group received treatment with a continuous 24-h intravenous infusion of 0.9% normal saline of the same volume.Laboratory parameters，clinical medications，pre- and post-treatment echocardiographic parameters，24-h urine volume during treatment，in-hospital mortality，length of stay，re-hospitalization within 1 month after discharge of both groups were collected and compared.Results　There were no significant differences in left ventricular end-diastolic diameter （LVEDD） and left atrioventricular valve annulus peak early diastolic velocity （e'） between the two groups after treatment for 24 h （P>0.05）．After 24-h treatment，the values of left ventricular ejection fraction （LVEF），left ventricular peak systolic pressure（S'），right ventricular fractional area change （FAC），and right atrioventricular annulus systolic displacement （TASPE） were significantly higher in Levosimandan group compared with those in the control group （P<0.05）．The values of peak early left ventricular diastolic blood flow velocity （E），E/e' and sPAP were lower in the Levosimendan group than those in the control group （P <0.05）．After 24-h treatment，Levosimendan group showed significantly increased values of LVEF，S'，right ventricular FAC，and TAPSE and significantly decreased values of E，E/e' and SPAP （P<0.05）．In the control group，post-treatment values of LVEDD，LVEF，E，e'，E/e'，S'，right ventricular FAC and TAPSE showed insignificant changes compared with the baseline （P>0.05），but the value of SPAP decreased significantly （P<0.05）．The average 24-h urine volume during treatment in Levosimendan group was more than that in the control group （P<0.05），but in-hospital mortality，length of stay，and re-hospitalization within 1 month after discharge in both groups were similar（P>0.05）．Conclusion　Levosimendan may improve the RV function and decrease the pulmonary artery pressure，without increasing the length of stay and rate of re-hospitalization in patients with ADHF.

Key words: Heart failure, Right ventricular function, Levosimendan, Echocardiography, Treatment outcome

摘要： 背景　目前多种正性肌力药物应用于临床，但因其可能增加心律失常发生率及病死率而应用受限。左西孟旦是一种新型正性肌力药物，其应用于右心力衰竭的治疗经验和研究相对较少。目的　探讨左西孟旦对急性失代偿性心力衰竭（ADHF）患者右心功能的影响。方法　本研究为单中心随机对照研究。选取2017年1月—2018年1月于河北医科大学第二医院就诊的符合研究标准的ADHF患者79例。按照随机数字表法将患者分为左西孟旦组（n=40）和安慰剂组（n=39）。左西孟旦组患者在标准治疗基础上给予左西孟旦6~12 μg/kg，10 min内缓慢静脉注射，继而以0.1 μg•kg-1•min-1持续静脉泵入24 h。安慰剂组患者在标准治疗基础上给予等剂量0.9%氯化钠溶液。比较两组患者的实验室检查指标、临床用药情况；治疗前及治疗24 h后心功能指标、肺动脉收缩压（SPAP）；治疗期间24 h尿量、住院期间死亡情况、住院时间及1个月再住院情况。结果　两组患者治疗24 h后左心室舒张末期内径（LVEDD）和左房室瓣环舒张早期运动速度峰值（e'）比较，差异无统计学意义（P>0.05）；左西孟旦组患者治疗24 h后左心室射血分数（LVEF）、收缩峰值（S'）、右心室面积变化分数（FAC）、右房室瓣环收缩期位移（TASPE）高于安慰剂组，左房室瓣口舒张早期血流速度峰值（E）、E/e'、 SPAP低于安慰剂组（P<0.05）。治疗24 h后左西孟旦组患者LVEF、S'、FAC、TAPSE高于同组治疗前，E、E/e'、SPAP低于同组治疗前（P<0.05）；治疗前与治疗24 h后安慰剂组患者组内LVEDD、LVEF、E、e'、E/e'、S'、FAC、TAPSE比较，差异无统计学意义（P>0.05）；治疗24 h后安慰剂组患者SPAP低于同组治疗前（P<0.05）。左西孟旦组治疗期间24 h尿量多于安慰剂组（P<0.05）；两组患者住院期间病死率、住院时间、1个月再住院率比较，差异无统计学意义（P>0.05）。结论　左西孟旦可以改善ADHF患者右心功能，降低肺动脉压力，且不增加患者住院时间及再住院次数，值得临床借鉴。

关键词: 心力衰竭, 右心功能, 左西孟旦, 超声心动描记术, 治疗结果