左西孟旦对严重瓣膜病合并心房颤动患者行心脏手术影响的随机对照试验  

Influence of Levosimendan on Severe Valvular Disease Patients with Atrial Fibrillation Undergoing Cardiac Surgery: A Randomized Controlled Trial

作　　者：于风旭[1] 付勇[1] 刘洪端[1] 李新[1] 范景秀[2] 廖斌[1] 石应康[2] 

机构地区：[1]泸州医学院附属医院心胸外科,四川泸州646000 [2]四川大学华西医院心脏大血管外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2015年第4期288-291,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省科技厅资助项目(2011JY0065)~~

摘　　要：目的比较左西孟旦与多巴胺用于合并心房颤动（房颤）的严重瓣膜疾病手术的疗效,探索左西孟旦用于心脏手术的有效性和安全性。方法将2014年2~6月泸州医学院附属医院48例患者用随机数字表法分为左西孟旦组[24例,男18例、女6例,年龄（52.3±16.2）岁）]和多巴胺组[24例,男15例、女9例,年龄（55.0±17.4）岁],比较两组患者的临床结果。结果左西孟旦组住院时间[（18.7±8.6）d vs（20.6±7.5）d,t=11.52,P=0.02]及急性肾损伤发生率[1/24 vs 5/24,χ^2=25.30,P=0.01]短于或低于多巴胺组,其余临床早期结果差异无统计学意义。术后各时间点两组肌酸激酶同工酶（CK-MB）差异无统计学意义,但术后6~48 h两组心肌肌钙蛋白I（c Tn I）、脑钠肽（BNP）差异有统计学意义（P〈0.05）。术后5 d左西孟旦组左心室射血分数（LVEF）高于多巴胺组。结论左西孟旦用于严重瓣膜病合并房颤患者手术安全有效,且有一定的心肌保护和肾保护作用,其机理尚需进一步探讨。Objective Through comparing the efficacy of levosimendan with dopamine for severe valvular disease patients with atrial fibrillation surgery to explore the efficacy and safety of levosimendan used in cardiac surgery. Methods We allocated 48 severe valvular disease patients with atrial fibrillation surgery into a dopamine group（24 patients with 15 males and 9 females at age of 55.0 ± 17.4 years） and a levosimendan group（24 patients with 18 males and 6 females at age of 52.3 ± 16.2 years） by random digital table in the Affiliated Hospital of Luzhou Medical College between February and June 2014. The effects of the two groups were compared. Results Hospitalization time（18.7±8.6 d vs 20.6±7.5 d, t=11.52,P=0.02） and the incidence of acute kidney injury（1/24 vs 5/24, χ^2=25.30,P=0.01） in the levosimendan group were lower than those in the dopamine group. There was no statistical difference between the two groups in other early clinical outcomes. At each postoperative time point, there was no statistical difference in creatine kinase isoenzyme（CK-MB） between the two groups. While 6 to 48 hours after operation, there were significant differences in cardiac troponin（c Tn I） and brain natriuretic peptide（BNP） level between the two groups（P0.05）. Five days after operation, the left ventricular ejection fraction（LVEF） in the levosimendan group was higher than that in the dopamine group with statistical difference. Conclusion Levosimendan used for severe valvular disease with atrial fibrillation surgery is safe and effective, and has certain myocardial protection and renal protection effect, while its mechanism still needs further study.

关 键 词：左西孟旦 瓣膜病 心房颤动 心脏手术 

分 类 号：R654.2[医药卫生—外科学]