目的 探讨左卡尼汀治疗慢性肾衰血液透析患者心功能的临床疗效。方法 选取2010年10月—2014年6月中国人民解放军第十一医院收治的慢性肾衰血液透析合并心力衰竭患者274例,随机分为对照组和治疗组,每组137例。两组患者均给予充分透析治疗,治疗组每次透析结束后5 min静脉推注注射用左卡尼汀,1 g溶于生理盐水10 mL。两组均连续治疗12周。观察两组患者的临床疗效,同时比较治疗前后心功能系数、心功能结构的变化。结果 对照组和治疗组总有效率分别为69.34%、91.24%,两组比较差异有统计学意义(P < 0.05)。治疗后两组患者心输出量(CO)、心脏指数(CI)、每搏心输出量(SV)、中心静脉压(CVP)、有效循环血量(ECV)、心肌耗氧量(MVO)、左室舒张末期容量(LDV)、左室舒张末期内径(LVIDd)、左室后壁厚度(LVPWT)、左室重量指数(LVMI)显著下降,射血分数(EF)、左室射血分数(LVEF)、E/A显著升高,同组治疗前后差异有统计学意义(P < 0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异有统计学意义(P < 0.05)。结论 左卡尼汀治疗慢性肾衰血液透析心力衰竭患者具有较好的临床疗效,可改善患者的心功能和心脏结构,值得临床广泛推广。

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.