【正文】 from treatment after 24 hours of each pulse blood transfusion volume (177。 ) ml, both contrast, no significant difference (P )。（4）Using digoxin arm joint levosimendan drug injection intravenous injection treatment of 100 patients with observation group before the treatment of nterminal brain titanium precursor sodium content (177。 ) pg/ml is different from treatment after 24 hours of the N terminal of the brain titanium precursor sodium content (177。 ) pg/ml, both parison, there were significant differences (P ), has the strong statistical difference。The NE content of patients before treatment (177。 ) pg/ml is different from treatment after 24 hours of each pulse blood transfusion volume (177。 ) pg/ml, both parison, there were significant differences (P ), has the strong statistical difference。(4) The conventional arm vein injection treatment of 100 patients with the control treatment before the N terminal of the brain titanium precursor sodium content (177。 ) pg/ml is different from treatment after 24 hours of the N terminal of the brain titanium precursor sodium content (177。 ) pg/ml, both contrast, no significant difference (P )。Patients before the NE content (177。 ) pg/ml is different from treatment after 24 hours of NE content (177。 ) pg/ml both parisons, significant differences (P ), no statistical difference。(6) The leosimendan intravenous injection treatment of 100 patients with observation group before the treatment of interleukin 6 levels (177。 / ) (ng/ml) is different from treatment after 24 hours of interleukin 6 levels (177。 ) (ng/ml), the parison between them, and there were significant differences (P ), has the strong statistical difference。Before treatment of patients with hs CRP levels (177。 ) (pg/ml) is different from treatment after 24 hours of the hs CRP levels (177。 ) (pg/ml), both parison, there were significant differences (P ), has the strong statistical difference。（7）The conventional arm vein injection treatment of 100 patients with the control group before treatment of interleukin 6 levels (177。 ) (ng/ml) is different from treatment after 24 hours of interleukin 6 levels (177。 ) (ng/ml), the parison between them, and there were significant differences (P ), has the strong statistical difference。Before treatment of patients with hs CRP levels (177。 ) (pg/ml) is different from treatment after 24 hours of the hs CRP levels (177。 ) (pg/ml), both contrast, no significant difference (P ).（8） The conventional arm vein injection treatment of 100 patients with the control group after treatment with the conventional arm vein injection treatment of 100 patients with the control group, left ventricular ejection fraction, each pulse blood transfusion volume, nterminal brain sodium contents of titanium precursor, NE, interleukin 6 levels and hs CRP levels are significantly higher than the control group, pared two groups of patients with total effective rate of treatment, has significant difference, P , with statistical significance.（9） The observation group, 100 cases of patients after intravenous injection of digoxin arm joint levosimendan injection drug injection therapy, 1 person, liver and kidney function in patients with abnormal electrolyte change 1 patients, severe hypotension and malignant patients with severe heart rate abnormal 0, number of adverse events happened in 2 cases, the incidence of adverse events was 2%。In the control group, 100 cases of patients after intravenous injection of digoxin arm injection drug treatment, 1 person, liver and kidney function in patients with abnormal electrolyte change of patients with 0, 1 patients with severe hypotension, and 1 malignant patients with severe heart disorder, number of adverse events occurred in 3 cases, the incidence of adverse events was 3%。Compared to two groups of patients the incidence of adverse events during the process of treatment, no significant difference, P , no statistical significance.Conclusion:In short, in the clinical treatment of patients with acute heart failure, can use levosimendan injections into patients with venous injection of drug therapy, this kind of method in treatment of patients with 24 hours after can effectively improve patient treatment effect, improve the quality of patient prognosis, obtain ideal therapeutic effect, is worth promoting in clinic.Key words：Levosimendan。Acute heart failure。Clinical observation on目 錄目 錄中英文對照說明 I前 言 11 急性心力衰竭概述 2 課題研究的意義 2 課題研究的現(xiàn)狀 22 資料與方法 5 一般資料 5 診斷方法 5 診斷標(biāo)準(zhǔn) 6 入選標(biāo)準(zhǔn) 6 排除標(biāo)準(zhǔn) 7 治療方法 7 觀察指標(biāo) 8 評價指標(biāo) 8 統(tǒng)計學(xué)方法 83 結(jié)果與分析 9 兩組患者一般資料統(tǒng)計結(jié)果分析 9 兩組患者治療前后LVEF(%)和SV(ML)狀況比較 10 兩組患者治療后LVEF(%)和SV(ML)狀況綜合比較 11 兩組患者治療前后NTproBNP(pg/ml)和NE(pg/ml)狀況比較 11 兩組患者治療后NTproBNP(pg/ml)和NE(pg/ml)狀況綜合比較 12 兩組患者治療前后IL6(ng/ml)和hsCRP(pg/ml)狀況比較 12 兩組患者治療后IL6和hsCRP狀況綜合比較 13 14 兩組患者不良事件發(fā)生率對比 154 討論 19： 19： 20： 20： 20參考文獻(xiàn) 26綜 述 28左西孟旦對心衰治療的研究進(jìn)展 291 心衰治療藥物綜述 29 ACEI(血管緊張素轉(zhuǎn)換酶抑制劑) 29 血管緊張素II受體阻滯劑(ARB) 30 B．受體阻滯劑 30 醛固酮拮抗劑 31 鈣增敏劑 31 腦鈉肽 33 內(nèi)皮素受體阻滯劑(ET) 34 Neregurelin 34 非藥物治療 342 左西孟旦（LS）的作用機制 35 活性代謝物 35 對心肌肌鈣蛋白C（cTnC）以及鈣離子作用 36 擴張血管 36 抗細(xì)胞凋亡、抗氧化劑抗炎作用 36 選擇性磷酸二酯酶（PDE3）抑制劑作用 36 鈣離子增敏作用 37 K+通道開放作用 373 LS應(yīng)用于各種心力衰竭研究 37 頑固性心力衰竭 37 心臟術(shù)后急性力衰竭 38 心腎綜合征 38 擴張型心肌病心力衰竭 38 急性心肌梗死后心力衰竭 394 總結(jié) 39參考文獻(xiàn) 40致 謝 41中英文對照說明中英文對照說明英文縮寫中文全稱HF心力衰竭AHF急性心力衰竭CCU心臟病監(jiān)護(hù)室TnC肌鈣蛋白CLVEF(%)左室射血分?jǐn)?shù)SV(ML)每博輸血量NTproBNP(pg/ml)氨基末端B型利鈉鈦前體 ADHF急性失代償心力衰竭IL6(ng/ml)白介素6BMI體重指數(shù)BP血壓SBP收縮壓DBP舒張壓WHO世界衛(wèi)生組織43前 言前 言 心力衰竭，在醫(yī)學(xué)界被簡稱為心衰，近些年來，隨著人類生活習(xí)性和身體狀況的改變，心力衰竭的發(fā)病人數(shù)在逐年增多，已經(jīng)成為即癌癥之后的又一人類生命殺手，為了應(yīng)對和緩解心力衰竭對人類造成的傷害，國內(nèi)外眾多學(xué)者和醫(yī)務(wù)人員投入到急性心力衰竭這類疾病治療研究中。當(dāng)今醫(yī)學(xué)界對心力衰竭的研究主要在心力衰竭的檢查和診斷方面，對心力衰竭的治療仍存在眾多空白。急性心力衰竭（AHF）是指患者心臟器官突發(fā)或急性發(fā)作的左心泵血功能異常，隨后導(dǎo)致患者正常的心肌收縮力降低、心臟承受射血負(fù)荷加重，導(dǎo)致在極短時間內(nèi)患者心臟泵血量、排血量驟降、肺器官空氣循環(huán)壓力升高、血管周圍循環(huán)阻力增加，引起患者內(nèi)臟器官肺循環(huán)充血，出現(xiàn)急性肺淤血、肺水腫并可伴患者表面體征組織、器官灌注不足和心源性休克的綜合臨床癥狀，發(fā)病期因以患者左心衰竭為主要表現(xiàn)。急性心衰的又一大誘因可能是患者原有的慢性心衰發(fā)作，引起病情加重，通?；颊叨喟殡S器質(zhì)性心血管疾病，發(fā)病時多表現(xiàn)為