左西孟旦对瓣膜置换术后心功能影响的临床研究  

Effect of levosimendan on cardiac function after valve replacement

作　　者：解鑫隆 尹晓清[1] 倪广生 项宇[2] XIE Xin-long;YIN Xiao-qing;NI Guang-sheng;XIANG Yu(Department of Cardiothoracic Surgery,First Affiliated Hospital,Hunan University of Traditional Chinese Medicine,Changsha 410007,China;Hunan University of Chinese Medicine,Changsha 410208,China)

机构地区：[1]湖南中医药大学第一附属医院心胸外科,湖南长沙410007 [2]湖南中医药大学,湖南长沙410208

出　　处：《实用药物与临床》2019年第5期508-512,共5页Practical Pharmacy and Clinical Remedies

基　　金：湖南省中医药科研计划项目(201788)

摘　　要：目的观察左西孟旦对瓣膜置换术后患者心功能的影响。方法选取2013年12月1日至2017年12月1日在湖南中医药大学第一附属医院心胸外科行心脏瓣膜置换手术的患者67例,随机分为对照组(35例,术后接受常规治疗)和左西孟旦组(32例,在常规治疗基础上给予左西孟旦治疗24 h)。所有患者术中留置Swan-Ganz导管,记录术毕、术后24 h、术后72 h肺毛细血管楔压(Pulmonary capillary wedge pressure,PCWP)、肺动脉平均压(Pulmonary average mean pressure,PAMP)、心输出量(Cardiac output,CO),同时抽取静脉血,检测氨基末端脑利钠肽前体(NT-proBNP)水平;术毕、术后7 d行超声心动图检查,记录左心室射血分数(LVEF)、短轴收缩率(FS);记录术后呼吸机辅助时间、ICU治疗时间及不良事件发生情况。结果术毕时,两组患者PCWP、PAMP、CO、NT-proBNP比较差异无统计学意义(P>0.05);术后24、72 h时,两组患者PCWP、PAMP、NT-proBNP较术毕时降低,CO较术毕时升高,且左西孟旦组PCWP、PAMP、NT-proBNP低于对照组,CO高于对照组,差异有统计学意义(P<0.05)。术毕时,两组患者LVEF、FS比较差异无统计学意义(P>0.05);术后7 d时,两组患者LVEF、FS显著高于术毕时,且左西孟旦组高于对照组,差异有统计学意义(P<0.05)。左西孟旦组术后呼吸机辅助时间、ICU治疗时间均较对照组显著减少(P<0.05),两组患者不良事件发生例数比较差异无统计学意义(P>0.05)。结论左西孟旦有助于改善心脏瓣膜置换术后患者的心功能,耐受性和安全性好。Objective To observe the effect of levosimendan on cardiac function after valve replacement.Methods A total of 67 patients who received heart valve replacement surgery were enrolled into this study from December 1,2013 to December 1,2017.They were randomized into 2 groups:levosimendan group(n=32)and control group(n=37).Patients in control group received conventional treatment and patients in levosimendan group received the same conventional treatment plus levosimendan for 24 hours.All patients were retained the Swan-Ganz catheter in the operation.Pulmonary capillary pressure(PCWP),pulmonary average mean value(PAMP),and cardiac output(CO)were recorded immediately after operation and at 24 h and 72 h after operation.Meanwhile,venous blood was extracted to detect NT-proBNP.All patients underwent echocardiography after operation and 7 d after surgery,and the left ventricular ejection fraction(LVEF)and short-axis systolic rate(FS)were recorded.Postoperative ventilator-assisted time,ICU treatment time and adverse events were recorded.Results There were no significant differences in PCWP,PAMP,CO or NT-proBNP between the two groups at 24 h(P>0.05).At 24 h and 72 h,the levels of PCWP,PAMP and NT-proBNP in the two groups were decreased,while CO was increased(P<0.05);PCWP,PAMP and NT-proBNP in levosimendan group were lower than those in control group(P<0.05),and CO was higher than that in control group(P<0.05).There were no significant differences in LVEF or FS between the two groups after operation(P>0.05).At 7 days after operation,the levels of LVEF and FS in the two groups were significantly higher than those after operation,and the levels in levosimendan group were higher than those in control group(P<0.05).The ventilator-assisted time and ICU treatment time in levosimendan group were shorter than those in control group(P<0.05).There was no significant difference in the number of adverse events between the two groups(P>0.05).Conclusion Levosimendan is helpful to improve the cardiac function,tolerance and safety in patie

关 键 词：左西孟旦 心脏瓣膜置换手术 心功能 

分 类 号：R654.2[医药卫生—外科学]