青岛大学硕士学位论文左卡尼汀用于治疗扩张型心肌病的疗效观察及血药浓度监测摘要目的：观察对扩张型心肌病患者的临床治疗中，加用左卡尼汀L-carnitine,L-CN)注射剂后，患者的病情变化以及患者体内左卡尼汀及代谢产物的血药浓度情况。探讨左卡尼汀用于扩张型心肌病的疗效，同时观察其用药前后左卡尼汀的血药浓度含量，从而进一步确定左卡尼汀在治疗扩张型心肌病方面的效果，探寻左卡尼汀的血药浓度与心功能各项指标改善的相关性。方法：选择2011年2月至2012年4月间与我院住院治疗的经临床及影像学诊断确诊为扩张型心肌病的患者30例，并将所有患者随机分为实验组和对照组各15人。对照组应用心内科扩张型心肌病常规治疗，使用利尿剂、AC1类药物、洋地黄类强心药、血管扩张剂等：实验组在使用心内科扩张型心肌病常规治疗的基础上，加用左卡尼汀治疗，比较两组在用药前后左室舒张末期内径(left ventricular end diastolicdiameter,LVEDD).左室射血分数(leftventricular ejection fraction,LVEF).短轴缩短率(fractional shortening,FS).心功能NYHA分级的变化。检测实验组使用左卡尼汀前后的血药浓度变化情况。结果：入选患者年龄、性别、病程、高血压、糖尿病等在两组间差异均无统计学意义(P>O.05),具有可比性；两组患者用药前左室舒张末期内径(left ventricular enddiastolic diameter,LVEDD).左室射血分数(leftventricular ejection fraction,LVEF).短轴缩短率(fractional shortening,FS).心功能NYHA分级差异无显著性(P>O.O5),具有可比性；L-CcN实验组治疗后7d、I4d的左室舒张末期内径(left ventricular end diastolicdiameter,,LVEDD)与对照组相比明显降低(P<0.01,P<0.05;L-CN实验组治疗后1d、7d及14d后的左室射血分数(leftventricular ejection fraction,LVEF)水平与对照组比较明显下降(P<0.05):L-CN实验组短轴缩短率(fractional shortening,FS)明显高于对照组(P<0.05)。静注L-CN未见与用药有关的不良反应。结论通过静脉注射左卡尼汀治疗扩张型心肌病的患者，其病情具有明显改善，症状有所缓解，同时未发现明显不良反应。结论：扩张型心肌病患者静脉注射左卡尼汀后，可以显著改善患者的心脏功能，缓青岛大学硕士学位论文解患者病情，对于改善扩张型心肌病患者的症状具有积极的意义。左卡尼汀可以增加心肌细胞的功能，减少负性变化，从而减少心血管不良事件的发生，对患者的预后有积极意义。关键词：左卡尼汀扩张型心肌病血药浓度Objective:To observe the patients with dilated cardiomyopathy clinical treatment,plusleft-handed Carney Dean L-carnitine,L-CN )patient's condition change and the serumconcentrations in patients with case.To explore Levocarnitine for the efficacy of dilatedcardiomyopathy,while observing the content of the blood concentration of its beforeand after administration of L-carnitine,which further determine the effect oflevocarnitine in the treatment of dilated cardiomyopathy,explore the left Carney Ting ofthe correlation between plasma concentration and the improvement of heart functionindicators.Methods:the School Affiliated Hospital in 2008February to2011February betweenoutpatient and inpatient treatment in patients with dilated cardiomyopathy in 30patients,all patients were confirmed by clinical and imaging diagnosis of diagnosed asdilated cardiomyopathy,all the patients were randomly divided into observation groupand control group each 15 people.The control group used the cardiology dilatedcardiomyopathy patients given routine treatment,cause and symptomatic treatment,limiting intake of salt,use of diuretics,ACEl class of drugs,digitalis cardiac drugs,vasodilators,detection of patients'vital signs,pay close attention to the change of thepatient's condition,the unexpected situation promptly notify the attending physician,immediate symptomatic processing;the observation group in the use of Cardiologydilated cardiomyopathy on the basis of conventional therapy,combined withlevocarnitine therapy,were compared between the two groups before and after thetreatment in left ventricular end diastolic diameter left ventricular end diastolicdiameter,LVEDD )Left ventricular ejection fraction LEFTVENTRICULAR ejection fraction,LVEF )Fractional shortening fractional shortening,FS )NYHA changes in cardiacfunction classification.Detection of the observation group used L-carnitine after blood青岛大学硕士学位论文concentration change.Results:the selected patient age,gender,duration of diabetes,hypertension,and thedifference between the two groups were not statistically significant P >0.05),comparable;two groups of patients before treatment,left ventricular end diastolicdiameter left ventricular end diastolic diameter,LVEDD )Left ventricular ejectionfraction LEFTVENTRICULAR ejection fraction,LVEF )Fractional shortening fractionalshortening,FS )NYHA grading of heart function had no significant difference (P>0.05),comparable;L-CN treatment group after the7d 14d left ventricular end diastolicdiameter left ventricular end diastolic diameter,LVEDD )compared with the controlgroup decreased significantly (P<0.01,P<0.05);L-CN treatment group after the 1d.7dand 14d of left ventricular ejection fraction LEFTVENTRICULAR ejection fraction,LVEFlevels compared with the control group decreased significantly P 0.05);L-CNtreatment group,fractional shortening fractional shortening,FS was significantlyhigher than that of the control group P <0.05).Intravenous or oral L-CN were observedand drug related adverse reaction.Conclusion L-CN intravenous or oral therapy inpatients with dilated cardiomyopathy,has markedly improved the patient,alleviate thepatient,while no obvious adverse reaction.Conclusion:in patients with dilated cardiomyopathy by intravenous or oral use ofL-carnitine,can significantly improve the patient's cardiac function,alleviate the patient's condition,retard or even reverse the patients for further development,dilatedcardiomyopathy patients with positive significance.L-carnitine helps to dilatedcardiomyopathy novel treatment modalities in appearance,can increase the myocardialcell function,reduce its negative changes,thereby improving and reversal of patients,reduce the adverse cardiovascular events,promote our heart discipline development,promoting human health.Keywords:L-carnitine Dilated cardiomyopathy Blood drug concentration3