左西孟旦在心脏瓣膜置换术后患者中的应用  

Effects of levosimendan on patients undergoing valve replacement

作　　者：生伟[1] 李娜[2] 池一凡[1] 牛兆倬[1] 张文峰[1] 吴建涛[1] 李好友 王天毅[1] 黄强[1] SHENG Wei;LI Na;CHI Yifan;NIU Zhaozhuo;ZHANG Wenfeng;WU Jiantao;LI Haoyou;WANG Tianyi;HUANG Qiang(Department of Cardiovascular Surgery,Qingdao Municipal Hospital,Medical College of Qingdao University,Qingdao,266071,Shandong,P.R.China;Department of Emergency Cardiology,Qingdao Municipal Hospital,Medical College of Qingdao University,Qingdao,266071,Shandong,P.R.China)

机构地区：[1]青岛大学附属青岛市市立医院心脏外科,山东青岛266071 [2]青岛大学附属青岛市市立医院急诊心内科,山东青岛266071

出　　处：《中国胸心血管外科临床杂志》2019年第7期693-697,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的观察左西孟旦在心脏瓣膜置换术后患者中应用的疗效及其对术后恢复的影响。方法前瞻性纳入青岛市市立医院心脏外科2014年1月至2018年5月期间收治的心脏瓣膜病患者185例,男122例、女63例。术前即随机分为左西孟旦组(n=93)和对照组(n=92),对照组患者术后行常规治疗。左西孟旦组患者除常规治疗外术后转入ICU即刻开始应用左西孟旦。比较两组临床效果。结果左西孟旦组患者术后各时间点的左室射血分数(LVEF)、心输出量(CO)较对照组明显升高,左西孟旦组和对照组患者术后7d的LVEF分别为:55.7%±2.5%、50.5%±2.2%,CO分别为(5.2±1.0)L/min、(4.4±1.1)L/min,差异均有统计学意义(P<0.05)。B型钠尿肽(BNP)水平明显下降,左西孟旦组和对照组患者术后7d的BNP分别为(312.5±34.6)pg/ml、(455.4±45.2)pg/ml,差异均有统计学意义(P<0.05)。左西孟旦组患者术后血管活性药剂量及给药时间明显小于或短于对照组[多巴胺剂量(11.5±1.8)mg/kgvs.(20.4±2.1)mg/kg;给药时间:(70.4±11.2)hvs.(110.5±12.1)h],ICU住院时间短于对照组[(24.6±4.3)hvs.(32.5±4.6)h],围术期并发症发生率明显低于对照组(9.7%vs.27.2%),差异均有统计学意义(P<0.05)。结论心脏瓣膜置换术患者术后即刻应用左西孟旦泵入可明显改善患者的心功能状态,减少患者血管活性药物的使用,缩短ICU监护时间,降低心脏术后不良事件发生率,加速瓣膜置换术患者的术后康复。Objective To investigate the effect of postoperative use of levosimendan on patients with valve replacement. Method Patients with valvular diseases who underwent valve replacement were prospectively enrolled during Jan 2014 to May 2018 in Qingdao Municipal Hospital, randomized to a levosimendan-treated group (n=93) and a control group (n=92) preoperatively. Patients in both groups underwent the same routine treatment preoperatively and postoperatively. In addition, patients in the levosimendan-treated group underwent levosimendan intravenous infusion 24 hours after entering ICU postoperatively. The clinical effect of the two groups was compared. Results Compared to the control group, the cardiac output(CO, 5.2±1.0 L/min vs. 4.4±1.1 L/min on the seventh day after surgery) and left ventricular ejection fraction (LVEF, 55.7%±2.5% vs. 50.5%±2.2% on the seventh day after surgery) of levosimendantreated group were increased significantly at different time points(1 day, 3 days and 7 days after surgery)(P<0.05), and the brain natriuetic peptid (BNP) level (312.5±34.6 pg/ml vs. 455.4±45.2 pg/ml on the seventh day after surgery) was less than that of the control group (P<0.05). The dosage (11.5±1.8 mg/kg vs. 20.4±2.1 mg/kg) and administration time of vasoactive agents in the levosimendan-treated group were significantly lower or shorter than those in the control group (70.4±11.2 h vs. 110.5±12.1 h, P<0.05). The ICU stay length, and the total incidence of adverse events were less than those of the control group (P<0.05). Conclusion Postoperative use of levosimendan immediately after surgery can significantly improve the cardiac function status of patients who underwent valve replacement, reduce the dosage of vasoactive agents, shorten the time of ICU hospitalization, reduce the incidence of adverse events and enhance the patient’s recovery after valve replacement.

关 键 词：左西孟旦 瓣膜置换 心功能 

分 类 号：R654.2[医药卫生—外科学]