左西孟旦对冠状动脉旁路移植术术后因左心功能不全应用主动脉内球囊反搏患者预后影响  

Effect of Levosimendan on patients combined with intra aortic balloon pump after severe coronary artery bypass grafting

作　　者：宋之明 丁雅刚 侯杰[2] 刘志刚[3] 樊国亮[3] SONG Zhi-ming;DING Ya-gang;HOU Jie;LIU Zhi-gang;FAN Guo-liang(Department of Cardiac Surgery,Shanghai East Hospital,Tongji University School of Medicine,Shanghai 200120,China;Department of Pharmacy,TED A International Cardiovascular Hospital,Tianjin 300457,China;Department of Cardiac Surgery,TED A International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]同济大学附属东方医院心脏大血管外科,上海市200120 [2]泰达国际心血管病医院药剂科 [3]泰达国际心血管病医院心脏大血管外科

出　　处：《中国心血管病研究》2021年第1期36-41,共6页Chinese Journal of Cardiovascular Research

基　　金：国家重点研发专项(2016YFC1302001)。

摘　　要：探讨左西孟旦对冠状动脉旁路移植术术后因左心功能不全应用主动脉内球囊反搏(IABP)患者的影响。方法收集2017年1月至2019年4月泰达国际心血管病医院心脏大血管外科患者术后因左心功能不全应用IABP的112例患者的临床资料,并以应用“左西孟旦”为分组变量建立倾向匹配44对病例资料,比较两组术后住院时间,呼吸机应用时间,IABP应用时间,急性肾损伤(AKI)发生及术后30天内死亡等预后差异,通过二分类法Logistic回归分析对术后AKI发生的独立危险因素进行分析。结果左西孟旦可以缩短冠状动脉旁路移植术围手术期因左心功能不全主动脉球囊反搏患者在呼吸机应用时间(36.7±.32.3 vs 55.6±.37.8,p=0.014),IABP应用时间(7.73±5.8 vs 10.5±5.8,p=0.028),ICU住院时间(92.5±59.7 vs 115.5±43.1,p=0.041)上有统计学差异。术后30天内全因死亡率(5(11.4%)vs 4(9.1%),P=1.000无统计学差异。该类患者AKI发生的独立危险因素有:术前糖尿病(OR 2.24295%CI:0.972~5.287)、LVEF<40%(OR 2.57195%CI:0.980~6.740)、CPB>3h(OR 1.87495%CI:1.238~5.597)(P<0.05);同时左西孟旦应用属于保护性因素:(OR0.27595%CI:0.112~0.675),(P<0.05。结论左西孟旦可以缩短冠状动脉旁路移植术围手术期因左心功能不全主动脉球囊反搏患者呼吸机应用时间、IABP应用时间以及ICU住院时间,并对肾功能有明显的保护作用,但并不减少术后30天死亡率。Objective To investigate the effect of Levosimendan on intra aortic balloon pump(IABP)in patients with left cardiac dysfunction after coronary artery bypass grafting.Methods The data of 112 patients undergne IABP bacause of left cardiac dysfunction after coronary artery bypass grafting admited in Dep.Heart Vascular Surgery,TEDA International Cardiovascular Hospital from Jan 2017 to Apr 2019 were reviewd.By applying Levosimendan as grouping variable to establish tendency of matching,the data of 44 pairs were used to compare the two groups'postoperative hospital stay,breathing machine application time.IABP application time,acute kidney injury(AKI)and the prognosis of postoperative death within 30 days.Two taxonomy Logistic regression analysis were used analyze the independent risk factors for postoperative AKI.Results Levosimendan group took the time shorten significantly in the duration of ventilator application[(36.7±32.3)h vs.(55.6±37.8)h,P=0.014 J,duration of IABP application[(7.7±5.8)d vs.(10.5±5.8)d,P=0.028]and length of ICU stay[(92.5±59.7)h vs.(115.5±43.1)h、P=0.041]in patients with aortic balloon contractions due to left ventricular dysfunction during the perioperative period of coronary artery bypass grafting.The all-cause mortality rate within 30 days after surgery[5(11.4%)vs.4(9.1%),P=1.000]showed no statistical difference.The independent risk factors for AKI in these patients were preoperative diabetes mellitus(OR=2.242,95%CI0.972-5.287),LVEF<40%(0R=2.571,95%CI0.980-6.740),CPB>3 h(OR=1.874,95%CI1.238-5.597,P<0.05).The application of Levosimendan was a protective factor(OR=0.275,95%CI0.112-0.675,P<0.05).Conclusion Levosimendan can shorten the time of ventilator application,IABP application and ICU stay in patients with left cardiac dysfunction during perioperative period of coronary artery bypass grafting and has an obvious protective effect on renal function,but does not reduce the postoperative mortality at 30 days.

关 键 词：冠状动脉旁路移植术 左心功能不全 主动脉球囊反搏 急性肾功能损伤 左西孟旦 

分 类 号：R654.2[医药卫生—外科学]