OPCABG术前预防性应用左西孟旦治疗低LVEF冠心病63例  

Preoperative uses of levosimendan in patients with low LVEF undergoing OPCABG

作　　者：生伟[1] 池一凡[1] 牛兆倬[1] 张文峰 吴建涛[1] 李好友 王天毅 李娜[1] Sheng Wei;Chi Yifan;Niu Zhaozhuo;Zhang Wenfeng;Wu Jiantao;Li Haoyou;Wang Tianyi;Li Na(Department of Cardiac Surgery,Qingdao Municipal Hospital,Medical College of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛市市立医院心脏外科,266000

出　　处：《中华胸心血管外科杂志》2019年第2期91-93,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨非体外循环下冠状动脉旁路移植(OPCABG)术前应用左西孟旦对左心室功能低下[左心室射血分数(LVEF)≤0.40]的冠心病患者预后的影响。方法前瞻性纳入2015年6月至2018年5月63例接受OPCABG术的左心室功能低下的冠心病患者,其中男45例,女18例;年龄50~79岁,平均(66.8±8.2)岁。术前数字表法随机分为左西孟旦组(32例,术前24h应用左西孟旦)和对照组(31例)。患者均行常温OPCABG术,选用乳内动脉、大隐静脉作旁路移植材料。比较两组治疗期间血流动力学变化和心功能变化。结果术后12、24h时,左西孟旦组体循环阻力、中心静脉压较对照组下降,心输出量、LVEF较对照组明显升高,差异均有统计学意义(P<0.05);两组心率、平均动脉压差异无统计学意义(P>0.05)。术后血管活性药物剂量、给药时间明显少于对照组,机械通气时间、ICU住院时间、术后1天和2天B型钠尿肽水平、新发房颤发生比例均少于对照组,围手术期主动脉内球囊反搏(IABP)置入率明显低于对照组,差异均有统计学意义(P<0.05)。结论OPCABG术前应用左西孟旦可明显改善低LVEF冠心病患者术后血流动力学和心功能状态,缩短呼吸机辅助时间和ICU住院时间,降低不良事件发生比例。Objective To investigate the effect of preoperative uses of levosimendan in patients with low LVEF(≤0.40) undergoing off-pump coronary artery bypass grafting(OPCABG). Methods 63 patients with low LVEF coronary artery diseases were prospectively enrolled during June 2015 to May 2018,randomized to levosimendan-treated group(n=32) and control group(n=31)preoperatively. Patients in levosimendan-treated group underwent levosimendan intravenous infusion 24 h before OPCABG. All patients underwent OPCABG at normal temperature. Internal mammary artery and great saphenous vein were used as bypass materials. Hemodynamics and cardiac function were compared between the two groups after OPCABG. Results Compared to control group,the systemic vascular resistance(SVR) and central venous pressure(CVP) of levosimendan-treated group were decreased significantly and the CO and LVEF increased significantly at 12h and 24h after surgery(P<0.05). The heart rate and mean artery pressure had no statistical difference between the two groups(P>0.05). The dosage and administration time of vasoactive agents in levosimendan-treated group were significantly smaller than those in control group(P<0.05). The time of mechanical ventilation,the ICU stay length,the BNP level in the first two days after operation,and the incidence of new atrial fibrillation were less than those of the control group(P<0.05). The perioperative intra-aortic balloon pump implantation rate in levosimendan-treated group was significantly lower than that of the control group(P<0.05). Conclusion Preoperative use of levosimendan can significantly improve the hemodynamic and cardiac function status of patients with low LVEF after OPCABG,shorten the time of ventilator assisted and ICU hospitalization,and reduce the incidence of adverse events.

关 键 词：冠状动脉旁路移植 非体外循环 术前 左西孟旦 血流动力学 心功能 

分 类 号：R654.2[医药卫生—外科学]