左西孟旦与多巴酚丁胺应用于重症瓣膜病患者围术期效果的随机对照试验  

Effectiveness of Levosimendan versus Dobutamine for the Patients with Severe Valvular Disease in Perioperative Period: A Randomized Controlled Trial

作　　者：黄园琴[1] 李颖[1] 危宇[1] 刘彬[1] 许卫江[1] 

机构地区：[1]武汉亚洲心脏病医院重症监护室,武汉430022

出　　处：《中国胸心血管外科临床杂志》2015年第5期423-427,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：武汉市卫计委资助项目(600168)~~

摘　　要：目的探索左西孟旦注射液与多巴酚丁胺在重症瓣膜病患者围术期临床应用效果的差异。方法采用随机、单盲药物对照研究方法。纳入2010年4月至2013年6月在武汉亚洲心脏病医院59例围手术期重症瓣膜病患者,患者Swan-Ganz导管检查后肺毛细血管楔压（PCWP）≥15 mm Hg,心排血量指数（CI）≤2.5 L/（min·m^2）,血流动力学稳定,其中男48例、女11例,年龄18-70（51±14）岁。采用随机数字表法将患者分为左西孟旦组（25例）和多巴酚丁胺组（34例）,在接受心力衰竭治疗的基础上分别接受左西孟旦或多巴酚丁胺静脉滴注24 h。结果左西孟旦组治疗24 h后的PCWP较基线水平降低[（12.51±8.76）]mm Hg vs.（20.11±8.04）mm Hg,P〈0.01],CI较基线水平升高[（2.58±0.72）L/（min·m^2）vs.（2.01±0.54）L/（min·m^2）,P〈0.05],差异均有统计学意义。左西孟旦组肺毛细血管楔压（PCWP）、肺动脉平均压（PAMP）、全身血管阻力（SVR）和左心室射血分数（LVEF）在治疗24 h后与基线水平的差值较多巴酚丁胺组改善（P〈0.05）,差异有统计学意义。左西孟旦组脱机时间[（47.3±10.4）h vs.（52.5±7.6）h,P〈0.05]、ICU留滞时间[（5.3±2.2）d vs.（6.8±3.5）d,P〈0.05]均较多巴酚丁胺组缩短,差异有统计学意义。两组不良事件发生率差异无统计学意义（P〉0.05）。结论与多巴酚丁胺比较,左西孟旦能改善重症瓣膜病患者围术期的血流动力学状况,耐受性和安全性良好。Objective To explore the effectiveness of levosimendan versus dobutamine for the patients with severe valvular disease in perioperative period. Methods A randomized, single-blind, and controlled study was conducted in 59 patients with severe valvular disease in perioperative period. There were 48 males and 11 females at average age of 51±14 years（ranged from 18 to 70 years）. The patients received Swan-Ganz catheterization with pulmonary capillary wedge pressure（PCWP） ≥ 15 mm Hg, cardiac index（CI） ≤ 2.5 L/（min · m^2）, and hemodynamic stability. They were divided into a levosimendan group（n=25） and a dobutamine group（n=34） to receive levosimendan or dobutamine injection intravenously for 24 hours on base of anti-heart failure treatment by random digital table. Results In the levosimendan group, the level of PCWP was lower than the baseline level with a statistical difference（12.51±8.76 mm Hg vs. 20.11±8.04 mm Hg,P〈0.01） after 24 hours＇ treatment, and the level of CI was higher than the baseline level with a statistical difference（2.58±0.72 L/（min · m^2） vs. 2.01±0.54 L/（min · m^2）, P〈0.05） after 24 hours＇ treatment. In the levosimendan group, the changes of pulmonary capillary wedge pressure（PCWP）, pulmonary arterial mean pressure（PAMP）, sequential vascular response（SVR）, and left ventricular ejection fraction（LVEF） were more obvious compared with those in the dobutamine group with statistical differences（all P〈0.05） after 24 hours＇ treatment. The offline time and ICU stay in the levosimendan group reduced compared with those of the dobutamine group with statistical differences（47.3±10.4 h vs. 52.5±7.6 h, P〈0.05; 5.3±2.2 d vs. 6.8±3.5 d,P〈0.05）. There was no statistical difference in the incidence of adverse events between the two groups（P〉0.05）. Conclusion Compared with dobutamine, levosimendan can improve hemodynamic stability of patients with severe valvular disease in perioperative period with good tolerability

关 键 词：左西孟旦 多巴酚丁胺 重症瓣膜病 围手术期 

分 类 号：R654.2[医药卫生—外科学]