左西孟旦联合多巴酚丁胺治疗老年急性心肌梗死合并心源性休克患者的临床研究  

Levosimendan combined with dobutamine in treatment of elderly acute myocardial infarction patients with cardiogenic shock

作　　者：张源波 张笑笑 石宇杰[1] 田新利[1] 崔振双[1] 韩运峰[1] 高超[1] 贡玉苗 李俊峡 刘宇[3] Zhang Yuanbo;Zhang Xiaoxiao;Shi Yujie;Tian Xinli;Cui Zhenshuang;Han Yunfeng;Gao Chao;Gong Yumiao;Li Junxia;Liu Yu(Department of Cardiovascular Medicine,Chinese PLA General Hospital No.7 Medical Center,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心心血管病研究所,北京100700 [2]北京中医药大学研究生院 [3]北京中医药大学东直门医院急诊科

出　　处：《中华老年心脑血管病杂志》2020年第8期824-827,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：中央高校基本科研业务费专项基金(2019-JYB-JS-056);中华国际医学交流基金会心血管多学科整合思维研究基金(Z-2016-23-1823)。

摘　　要：目的探讨左西孟旦联合多巴酚丁胺对老年急性心肌梗死(AMI)合并心源性休克(CS)患者的疗效及预后。方法选择2家医院老年AMI合并CS患者60例,随机分为治疗组和对照组,每组30例,对照组给予多巴酚丁胺治疗,治疗组在对照组治疗基础上加用左西孟旦治疗,随访28 d记录预后情况。结果与治疗前比较,2组治疗后24 h、72 h平均动脉压、每搏量、氧分压、氧合指数、中心静脉血氧饱和度、乳酸清除率、尿量、LVEF明显升高,心率、左心室舒张末期容积、中心静脉压、乳酸、N末端B型钠尿肽前体明显下降(P<0.05)。治疗组休克持续时间、去甲肾上腺素用量、多巴酚丁胺用量、住监护室时间、主动脉内球囊反搏使用时间明显低于对照组[(5.30±0.40)d vs(8.40±0.50)d,(0.50±0.05)μg/(kg·min)vs(1.00±0.05)μg/(kg·min),(7.00±2.75)μg/(kg·min)vs(14.00±2.15)μg/(kg·min),(10.40±1.80)d vs(13.50±2.60)d,(56.28±14.83)h vs(78.76±12.34)h;P<0.05,P<0.01]。随访28 d,Kaplan-Meire生存曲线显示,治疗组生存率明显高于对照组(PLog-rank=0.02)。结论左西孟旦联合多巴酚丁胺治疗老年AMI合并CS具有较好临床疗效,能增强心功能,稳定血流动力学,改善组织灌注氧代谢,减少休克时间、住院时间和主动脉内球囊反搏使用时间,并且可降低28 d全因病死率。Objective To study the clinical efficiency of levosimendan combined with dobutamine and the prognosis in elderly AMI patients with cardiogenic shock(CS).Methods Sixty elderly AMI patients with CS were randomly divided into treatment group(n=30)and control group(n=30).The patients in control group were treated with dobutamine and those in treatment group were treated with dobutamine plus levosimendan.The patients were followed up for 28 days,during which their prognosis was recorded.Results The MAP,SV,PaO2,OI,ScvO2,lactate clearance rate,urine volume,LVEF were significantly higher while the HR,LVEDV,CVP,serum lactate and NT-proBNP levels were significantly lower in two groups at 24 h and 72 h after treatment than before treatment(P<0.05).The duration of shock and the ICU stay time,IABP using time were significantly shorter,the dosage of noradrenaline and dobutamine was significantly lower in treatment group than in control group(5.30±0.40 d vs 8.40±0.50 d,10.40±1.80 d vs 13.50±2.60 d,56.28±14.83 h vs 78.76±12.34 h,0.50±0.05μg/kg·min vs 1.00±0.05μg/kg·min,7.00±2.75μg/kg·min vs 14.00±2.15μg/kg·min;P<0.05,P<0.01).Kaplan-Meiresurvival curve analysis showed that the survival rate was significantly higher in treatment group than in control group during the 28-day follow-up period(PLog-rank=0.02).Conclusion Levosimendan combined with dobutamine can effectively improve the therapeutic effect,cardiac function,tissue perfusion,stabilize the hemodynamics and oxygen metabolism,shorten the shock time,hospital stay time and IABP using time,and reduce the all-cause mortality in elderly AMI patients with CS during the 28-day follow-up period.

关 键 词：多巴酚丁胺 心肌梗死 休克 心源性 肌钙蛋白I 强心药 

分 类 号：R542.22[医药卫生—心血管疾病] R541.64[医药卫生—内科学]