左西孟旦对重症冠状动脉旁路移植患者术后血流动力学的影响  

Hemodynamic of levosimendan in patients with severe coronary artery bypass grafting

作　　者：陈祖君[1] 裴锋博[1] 吴慧[1] 张志鹏[1] 龚黎[1] 姚垚[1] 杨立猛[1] 刘平[1] 施野[1] 杜鹃[1] 张海涛[1] 路天怡[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心血管疾病国家重点实验室,100037

出　　处：《中华胸心血管外科杂志》2015年第5期297-299,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨左西孟旦对心脏外科术后重症冠状动脉旁路移植患者血流动力学的影响.方法 前瞻性纳入阜外医院2013年12月至2014年9月期间第二成人外科恢复室收治的重症冠状动脉旁路移植患者.患者均行全麻低温体外循环下冠状动脉旁路移植（CABG）术,常规经主动脉及腔静脉建立体外循环,经主动脉根部顺行灌注停跳液,选用乳内动脉及大隐静脉行CABG术.术后数字表法随机分为左西孟旦组和对照组,比较两组患者治疗期间血流动力学变化.结果 左西孟旦组患者术后12h及24 h时体循环阻力及中心静脉压均较对照组下降,心输出量较对照组明显升高,差异均有统计学意义（P＜0.05）.两组患者心率及血压差异无统计学意义（P＞0.05）.术后24 h超声心动图检查结果示左西孟旦组患者左心室射血分数值较基线值改善明显,优于对照组[（0.11±0.06）对（0.05±0.02）,P＜0.05].左西孟旦组术后机械通气时间、新发房颤、急性肾损伤发生比例均小于对照组,差异均有统计学意义（P＜0.05）.结论 左西孟旦可改善重症冠状动脉旁路移植患者术后心功能,降低不良事件发生率.Objective To investigate the hemodynamic effects of levosimendan in patients post severe coronary artery bypass grafting.Methods Patients with severe coronary artery bypass grafting were prospectively enrolled during December 2013 to September 2014 in Fuwai Hospital,randomized to levosimendan-treated group and control group.The hemodynamic changes of the two groups were compared.Results Compared to control group,the SVR and CVP of levosiwendan-treated group were decreased significantly and the CO increased significantly at 12 h and 24 h post operation（P ＜ 0.05）.The heart rate and blood pressure had no statistical difference between the two groups.Compared with the baseline level,EF increased at 24 h in the levosimendan group（0.11 ± 0.06 vs.0.05 ± 0.02,P ＜ 0.05）.The incidence of postoperative mechanical ventilation time,new atrial fibrillation and acute kidney injury rate were all lower in the levosimendan-treated group than the control group with statistical defferences.Conclusion Levosimendan improved heart function and reduce the incidence of adverse events in patients post severe coronary artery bypass grafting.

关 键 词：心肺转流术 左西孟旦 血流动力学 肾/损伤 

分 类 号：R654.2[医药卫生—外科学]