左西孟旦与米力农在心脏瓣膜置换术围术期的心肌保护作用研究  

Comparison of myocardial protective effects between levosimendan and milrinone during perioperative period of cardiac valve replacement

作　　者：同鑫 金冉[1] TONG Xin;JIN Ran(Department of Anesthesiology,the First People's Hospital of Zhengzhou,Zhengzhou 454000,China)

机构地区：[1]郑州市第一人民医院麻醉科,郑州454000

出　　处：《实用药物与临床》2019年第1期43-46,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的分析比较左西孟旦与米力农在心脏瓣膜置换术围术期的心肌保护作用。方法 60例需要在体外循环辅助下进行心脏瓣膜置换的患者随机分为左西孟旦组、米力农组及对照组,每组20例。左西孟旦组使用左西孟旦注射液,米力农组使用米力农注射液。分别在麻醉诱导后,升主动脉开放后1、8 h,术后24、48 h检测患者血浆心肌肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)及磷酸肌酸激酶同工酶(CK-MB)含量,观察各组患者术后心脏自动复跳率,并记录三组患者术后监护时间。结果与对照组比较,左西孟旦组和米力农组主动脉开放1 h至术后48 h,患者cTnI、LDH与CK-M B明显降低,且左西孟旦组明显低于米力农组,差异有统计学意义(P <0. 05);左西孟旦组和米力农组患者自动复跳率明显高于对照组,且左西孟旦组明显高于米力农组,差异有统计学意义(P <0. 05)。左西孟旦组和米力农组患者术后拔管时间、ICU监护时间均短于对照组,且左西孟旦组短于米力农组,差异有统计学意义(P <0. 05);三组患者术后住院时间比较差异无统计学意义(P> 0. 05)。结论左西孟旦与米力农对心脏瓣膜置换术患者围术期的心肌缺血再灌注损伤均有明显的保护作用,可增强患者术后心肌收缩力,缩短患者康复时间,左西孟旦较米力农效果更为明显。Objective To compare the perioperative myocardial protective effects of levosimendan with that of milrinone in patients undergoing cardiac valve replacement.Methods Sixty patients who needed cardiac valve replacement assisted by cardiopulmonary bypass were randomly divided into levosimendan group,milrinone group and control group,with 20 cases in each group.Levosimendan group was treated with levosimendan injection,and milrinone group was treated with milrinone injection.Plasma levels of cardiac troponin I(cTnI),lactate dehydrogenase(LDH)and creatine kinase isoenzyme(CK-MB)were measured at 1 h and 8 h after opening ascending aorta,and at 24 h and 48 h after operation.The spontaneous heart rebeating rate after operation was observed,and the postoperative monitoring time of the three groups was recorded.Results Compared with control group,cTnI,LDH and CK-MB in levosimendan group and milrinone group at 1 h after opening ascending aorta and 48 h after operation were significantly reduced,and the indexes in levosimendan group were lower than those in milrinone group(P<0.05).The spontaneous heart rebeating rate of levosimendan group and milrinone group were significantly higher than that of control group,and the rate in levosimendan group was higher than that in milrinone group(P<0.05).The postoperative extubation time and ICU monitoring time in levosimendan group and milrinone group were shorter than those of control group,and those in levosimendan group were the shortest among the three groups(P<0.05).There was no significant difference in postoperative hospitalization time among the three groups(P>0.05).Conclusion Levosimendan and milrinone can effectively protect myocardium from ischemia reperfusion injury during perioperative period of cardiac valve replacement,which can enhance the postoperative myocardial contractility and shorten the recovery time,and levosimendan is more effective than milrinone.

关 键 词：左西孟旦 米力农 心脏瓣膜置换 心肌缺血再灌注损伤 

分 类 号：R654.2[医药卫生—外科学]