目的 比較左西孟旦和多巴酚丁胺治療擴(kuò)張型心肌病的臨床效果。方法 選擇2016年11月-2019年6月南通市第六人民醫(yī)院收治的擴(kuò)張型心肌病患者128例，依據(jù)隨機(jī)數(shù)字表法將128例患者分為觀察組（n=64）與對(duì)照組（n=64）。對(duì)照組在常規(guī)治療的基礎(chǔ)上靜脈泵入鹽酸多巴酚丁胺注射液，5 μg/（kg·min），持續(xù)24 h。觀察組在常規(guī)治療的基礎(chǔ)上給予左西孟旦注射液，初始負(fù)荷劑量：6~12 μg/kg，靜注，時(shí)間>10 min，然后靜脈泵入0.05~0.2 μg/（kg·min），持續(xù)24 h。7 d為1個(gè)療程，兩組治療共1療程。觀察兩組患者的臨床療效，同時(shí)比較兩組治療前后的心功能指標(biāo)、心肌力學(xué)指標(biāo)和血清學(xué)指標(biāo)。結(jié)果 治療后，觀察組總有效率高于對(duì)照組（P<0.05）。治療后，兩組左室收縮末期容積（LVESV）、左室舒張末期容積（LVEDV）均降低，左室射血分?jǐn)?shù)（LVEF）均明顯升高（P<0.05），且觀察組LVESV、LVEDV均低于對(duì)照組，LVEF均高于對(duì)照組（P<0.05）。治療后，兩組長(zhǎng)軸應(yīng)變值（GLS）、徑向應(yīng)變值（GRS）、面積應(yīng)變值（GAS）均明顯增加（P<0.05），且觀察組GLS、GRS、GAS均高于對(duì)照組（P<0.05）。治療后，兩組半乳凝集素3（Gal-3）、β2微球蛋白（β2-MG）、可溶性ST2（sST2）水平均明顯降低（P<0.05），且觀察組Gal-3、β2-MG、sST2均低于對(duì)照組（P<0.05）。結(jié)論 左西孟旦治療擴(kuò)張型心肌病可顯著改善患者心功能，提高心肌收縮能力，抑制分泌Gal-3、β2-MG、sST2，提高療效，安全可靠，值得推薦于擴(kuò)張型心肌病患者的臨床治療。

Objective To compare the clinical efficacy of levosimendan and dobutamine in treatment of dilated cardiomyopathy. Methods Patients (128 cases) with dilated cardiomyopathy in the Sixth People's Hospital of Nantong from November 2016 to June 2019 were divided in to observation group (64 cases) and control group (64 cases) according to random number table method. Patients in the control group was intravenously injected with Dobutamine Hydrochloride Injection at 5 μg/(kg·min) for 24 h on the basis of conventional treatment. On the basis of conventional treatment, patients in the observation group was given Levosimendan Injection with an initial loading dose of 6-12 μg/kg, the infusion time was longer than 10 min, followed by intravenous pumping 0.05-0.2 μg/(kg·min) for 24 h. 7 days as a course of treatment, two groups were treated for 1 course. The clinical effects of two groups were observed, and the indexes of cardiac function, myocardial mechanics, and serology before and after treatment were compared.Results After treatment, the total effective rate of the observation group was higher than that of the control group (P<0.05). After treatment, LVESV and LVEDV in two groups were significantly decreased, but the LVEF were increased (P<0.05). And LVESV and LVEDV in the observation group were significantly lower than those in the control group, LVEF were higher than those in the control group (P<0.05). After treatment, GLS, GRS, and GAS in two groups were significantly increased (P<0.05). And GLS, GRS, and GAS in the observation group were significantly higher than those in the control group (P<0.05). After treatment, Gal-3, β2-MG, and sST2 in two groups were significantly decreased (P<0.05). And the levels of Gal-3, β2-MG, and sST2 in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Levosimendan in treatment of dilated cardiomyopathy can significantly improve the cardiac function and myocardial contractility, inhibit the secretion of Gal-3, β2-MG, sST2, and improve the efficacy, safety and reliability, it is worth recommending in the clinical treatment of patients with dilated cardiomyopathy.

R972