左西孟旦对脓毒症诱导心肌功能障碍患者血流动力学的影响及其机制研究  

作　　者：闫智杰[1] 李静[1] 夏芝辉[1] 韩飚[1] 吴丽丽[1] 潘毅[1] 

机构地区：[1]南昌大学第四附属医院重症医学科,江西330003

出　　处：《当代医学》2016年第27期3-5,共3页Contemporary Medicine

基　　金：江西省卫生厅计划基金项目(20155374)

摘　　要：目的观察左西孟旦对脓毒症诱导心肌功能障碍(sepsis induced myocardial dysfunction,SIMD)患者血流动力学及炎症因子的影响。方法采用多中心、随机、双盲、阳性药物对照方法。将SIMD患者分入左西孟旦组和多巴酚丁胺组,入选患者均用药前及用药后24h,从静脉采血5 m L,置于以EDTA抗凝的试管中后立即送检,使用荧光免疫法测定BNP浓度,用ELISA法检测血清样本中IL-1及TNF-α的浓度,通过脉搏指示连续心输出量测定(Picco)监测CI、GEDV、ITBV、EVLM。结果左西孟旦组较多巴酚丁胺组能够显著降低SIMD患者BNP和IL-1、TNF-α水平(P﹤0.05);左西孟旦组CI增加,GEDV、ITBV和EVLM降低较多巴酚丁胺组明显(P﹤0.05)。结论与多巴酚丁胺比较,左西孟旦可以更明显改善SIMD患者的血流动力学参数及减少炎症因子的含量,具有明显的抗炎症作用,更适用于SIMD患者。Objective To observe the effects of levosimendan on hemodynamics and inflammatory factors in patients with sepsis-induced myocardial dysfunction （SIMD）.Methods A randomized, double-blind, multicenter, positive controlled trial was performed. The SIMD patients were randomly divided into levosimendan group and dobutamine group. Five milliliter venous blood was collected 24 hours before and after treatment and stored in tubes with EDTA anticoagulant. The samples were immediately sent to determine the concentration of BNP byfluorescence＆amp;nbsp;immunoassay, test the serum content of IL-1 and TNF-α with ELISA, and monitor CI, GEDV, ITBV and EVLM by Pulse indicating continuous determination of cardiac output （Picco）.Results Levosimendan reduced significantly the serum concentrations of BNP, IL-1 and TNF-α in patients with SIMD compared to dobutamine （P〈0.05）. Furthermore, there were dramatically higher CI and lower GEDV, ITBV and EVLM in levosimendan group than dobutamine （P〈0.05）.Conclusion Compared to dobutamine, Levosimendan could obviously improve the hemodynamic indexes of patients with SIMD and decrease the concentrations of inflammatory factors. Consequently, levosimendan has apparent anti-inflammatory role and is more applicable to patients with SIMD.

关 键 词：左西孟旦 脓毒症 心肌功能障碍 血流动力学 炎症因子 

分 类 号：R459.7[医药卫生—急诊医学]