左西孟旦对心脏手术后左室射血分数<40%患者预后的影响  

Effect of levosimendan on the prognosis of patients with left ventricular ejection fraction less than 40% after cardiac surgery

作　　者：娜荷芽 法宪恩[1] 周玉阳[1] 刘雷[1] 王宏山[1] 柳兵[1] NA He-ya;FA Xian-en;ZHOU Yu-yang;LIU Lei;WANG Hong-shan;LIU Bing(Department of Cardiouascular Surgery,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450014,China)

机构地区：[1]郑州大学第二附属医院心血管外科,河南郑州450014

出　　处：《中华实用诊断与治疗杂志》2021年第5期513-515,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家重点研发计划(2016YFC1302001)。

摘　　要：目的观察心脏手术后左室射血分数(left ventricular ejection fraction, LVEF)<40%者应用左西孟旦治疗后LVEF变化,探讨左西孟旦对其预后的影响。方法心脏手术后LVEF<40%患者80例,40例采取常规治疗者为对照组,40例在常规治疗基础上静脉滴注左西孟旦者为观察组。比较2组年龄,男性、体质量指数>24 kg/m2、合并高血压比率及手术方式,体外循环时间,主动脉阻断时间;比较2组术前及术后0、12、48 h时LVEF和血浆乳酸水平;随访90 d,比较2组低心排血量综合征发生率及生存率。结果 2组年龄,男性、体质量指数>24 kg/m2、合并高血压比率,手术方式,体外循环时间,主动脉阻断时间比较差异均无统计学意义(P>0.05)。观察组术前及术后0 h时LVEF[(45.68±2.90)%、(39.85±3.60)%]、血浆乳酸水平[(1.65±0.07)、(2.79±0.32)mmol/L]与对照组[LVEF:(45.93±3.02)%、(38.35±4.29)%;血浆乳酸:(1.67±0.08)、(2.81±0.35)mmol/L]比较差异均无统计学意义(P>0.05),术后12、48 h时LVEF[(54.30±2.83)%、(67.55±6.72)%]高于对照组[(52.75±1.81)%、(62.45±4.68)%](P<0.05)、血浆乳酸水平[(2.32±0.18)、(1.59±0.11)mmol/L]低于对照组[(2.41±0.23)、(1.90±0.19)mmol/L](P<0.05);观察组、对照组术后0、12、48 h LVEF依次升高,血浆乳酸水平依次降低(P<0.05)。观察组术后90 d低心排血量综合征发生率(10.0%)低于对照组(32.5%)(P<0.05),生存率(95.0%)高于对照组(80.0%)(P<0.05)。结论心脏手术后LVEF<40%的患者应用左西孟旦可改善术后恢复期间的心输出量和组织灌注,减少低心排血量综合征的发生,提高生存率。Objective To observe the changes of left ventricular ejection fraction(LVEF) after cardiac surgery in patients with LVEF <40% after treatment with levosimendan, and to evaluate the effect of levosimendan on the prognosis. Methods Eighty patients with LVEF <40% after cardiac surgery were divided into 40 patients receiving conventional treatment(control group) and 40 patients receiving intravenous injection of levosimondan besides the conventional treatment(observation group) based on voluntary principle. The percentages of age, males, body mass index >24 kg/m2 and hypertension, surgical method, extracorporeal circulation time and aortic occlusion time were compared between two groups. LVEF and serum lactic acid level were compared before and 0, 12 and 48 h after surgery between two groups. After 90 days of follow-up, the incidence of low cardiac output syndrome and survival rate were compared between two groups. Results There were no significant differences in the percentages of age, males, body mass index >24 kg/m2 and hypertension, as well as the surgical method, extracorporeal circulation time and aortic occlusion time between two groups(P>0.05). There were no significant differences in LVEFs and the plasma lactic acid levels before and 0 h after surgery between observation group((45.68±2.90)%,(39.85±3.60)%;(1.65±0.07),(2.79±0.32) mmol/L) and control group((45.93±3.02)%,(38.35±4.29)%;(1.67±0.08),(2.81±0.35) mmol/L)(P>0.05). LEVFs were higher 12 and 24 h after surgery in observation group((54.30±2.83)%,(67.55±6.72)%) than those in control group((52.75±1.81)%,(62.45±4.68)%)(P<0.05), and the plasma lactic acid levels were lower in observation group((2.32±0.18),(1.59±0.11) mmol/L) than those in control group((2.41±0.23),(1.90±0.19) mmol/L)(P<0.05). LVEF increased gradually and the plasma lactic acid level decreased gradually 0, 12 and 24 h after surgery in both two groups(P<0.05). In 90 d after surgery, the incidence of low cardiac output syndrome was lower in observation group(10.0%) than that in c

关 键 词：心脏手术 左室射血分数 低心排血量综合征 左西孟旦 

分 类 号：R654.2[医药卫生—外科学]