左西孟旦对重症心脏瓣膜病患者术后血流动力学的影响  

Effect of levosimendan on postoperative hemodynamics in patients with severe valvular heart disease

作　　者：朱文明 邓伟伟[2] 雷静 王敏[1] 高洪锋[1] Zhu Wenming;Deng Weiwei;Lei Jing;Wang Min;Gao Hongfeng(Department of Intensive Care Unit,Wuhan Asia Heart Disease Hospital Xinjiang Hospital,XinjiangCardiovascular and Cerebrovascular Disease Hospital,Urumqi 830011,China;Department of Clinical Laboratory,Tumor Hospital Affiliated to Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]武汉亚洲心脏病医院新疆医院新疆心脑血管病医院重症医学科,乌鲁木齐830011 [2]新疆医科大学附属肿瘤医院检验科,乌鲁木齐830000

出　　处：《中国心血管杂志》2019年第4期333-338,共6页Chinese Journal of Cardiovascular Medicine

摘　　要：目的观察左西孟旦对重症心脏瓣膜病患者术后血流动力学的影响。方法选取2016年4月至2017年12月新疆心脑血管病医院重症心脏瓣膜病患者66例,采用随机数字表法分为左西孟旦组(33例,在常规治疗基础上给予左西孟旦治疗)和对照组(33例,术后接受多巴胺或多巴酚丁胺常规治疗)。记录两组术后即刻、12、24、48和72 h血流动力学各指标的变化;记录术前1 d、术后1、3和7 d的高敏肌钙蛋白I、肌酸激酶同工酶、N末端B型利钠肽原水平及术后不良事件。结果左西孟旦组术后24、48和72 h的外周血管阻力指数、中心静脉压、血管外肺水指数和血乳酸值均较对照组明显下降,而每搏输出量指数、左室每搏功指数和心指数显著升高(均为P<0.05)。左西孟旦组术后3和7 d的高敏肌钙蛋白I较对照组显著下降(t=16.27,P=0.01;t=18.15,P=0.00),术后1、3和7 d的N末端B型利钠肽原显著下降(t=16.27,P=0.01;t=10.18,P=0.02;t=22.21,P=0.00)。左西孟旦组的ICU滞留时间、呼吸机辅助时间和住院时间较对照组明显缩短(t=8.62,P=0.03;t=10.28,P=0.02;t=14.12,P=0.00),急性肾损伤发生率显著降低(t=3.99,P=0.04)。结论左西孟旦能改善重症心脏瓣膜病患者术后血流动力学状况,有助于患者心功能恢复,降低术后不良事件发生率。Objective To observe the effect of levosimendan on postoperative hemodynamics in patients with severe valvular heart disease.Methods Sixty-six patients with severe valvular disease in Xinjiang Cardiovascular and Cerebrovascular Disease Hospital from April 2016 to December 2017 were enrolled.They were randomly divided into levosimendan group(n=33)to receive levosimendan and control group(n=33)to receive routine treatment with dopamine or dobutamine.The hemodynamic parameters were measured immediately and at 12,24,48 and 72 h after the surgery.Cardiac troponin I,creatine kinase MB and N-terminal pro brain natriuretic peptide were measured before and at 1,3,7 d after the operation.All adverse events were recorded.Results Compared with the parameters of the control group,the systemic vascular resistance index,central venous pressure,extra vascular lung water index and the serum of lactic acid of the levosimendan group significantly decreased,while the every cardiac index,left ventricular stroke work index and heart index significantly increased(all P<0.05),at 24,48 and 72 h after the surgery.The level of cardiac troponin I in 3 and 7 d(t=16.27,P=0.01;t=18.15,P=0.00)and N-terminal pro brain natriuretic peptide in 1, 3 and 7 d (t = 16. 27, P = 0. 01;t = 10. 18, P = 0. 02;t =22. 21, P = 0. 00) significantly decreased after the surgery. The ICU retention time, ventilation time,hospitalization time and acute kidney injury were significantly reduced in levosimendan group (t =8. 62, P =0. 03;t =10. 28, P = 0. 02;t = 14. 12, P = 0. 00;t = 3. 99, P = 0. 04). Conclusions Levosimendancan significantly improve the hemodynamics and cardiac function of the patients with severe valvular heartdisease, reduce the incidence of postoperative adverse events.

关 键 词：左西孟旦 心脏瓣膜疾病 血流动力学 手术后并发症 

分 类 号：R54[医药卫生—心血管疾病]