左西孟旦在左心室功能低下患者不停跳冠状动脉旁路移植术中的应用

Clinical effects of levosimendan in patients with left ventricular systolic dysfunction under off-pump coronary artery bypass grafting

目的:探讨左西孟旦对左心室收缩功能低下患者在不停跳冠状动脉旁路移植术(CABG)中心肌保护效果。方法:本院心外科在2010年5月至2012年11月,抽取术前左室射血分数小于45%的CABG病例40例,随机分为试验组和对照组各20例,对照组在手术中开始应用多巴胺静脉维持泵入,试验组同期加用左西孟旦,初始负荷量为10μg/kg,注射时间10min,随即以0.1～0.2μg·kg-1·min-1起泵入持续23h。记录两组患者治疗后监护室滞留时间、房颤发生率、多巴胺治疗时间、30d死亡率、记录手术后前3d的床边心脏超声测量左心室射血分数(LVEF)值比较,以及手术后早期ICU即刻(0)、术后6、24、48h的肌钙蛋白I(cTnI)指标变化。结果:试验组和对照组均无死亡病例。与对照组比较,试验组患者手术后多巴胺治疗时间缩短(P<0.05),房颤发生率降低(P<0.05)。术后6h和24h试验组的cTnI指标低于对照组(P<0.05)。试验组第1、2天LVEF指标高于对照组(P<0.05)。其余无统计学差异(P>0.05)。结论:左西孟旦对于术前左心室收缩功能低下的CABG患者具有一定心肌保护作用。

To effect of levosimendan in investigate the clinical patients with lower left ventricular eject fraction （LVEF） under of pump coronary artery bypass grafting （CABG）. METHODS： From May 2010 to November 2012, 40 cases with lower LVEF below 45 undergo ing elective CABG were randomly derided into treatment group （20 cases） and control group （20 cases）. All the cases received dopamine treatment perioperatively, and levosimendan were additionally used in the treatment group. The ICU time, the incidence of atrial fibrillation （AF） ,the duration of dopamine use, the mortal ity in the first 30 days were recorded. The level of LVEF in the first 3 days and the cTnI at 0,6, 24,48 h after the operation were examined. RE SULTS：No case died in both groups. Comparingwith control group, treatment group had lower incidence of AF （P〈0. 05）, and shorter time of dopamine use （P〈0.05）. Treatment group had a higher LVEF in the first two days than those in control group （P〈0.05）. Treatment group had lower cTnI at the 6h and 24h time point af ter the operation than those in control group（P 〈0.05）. There was no remarkable difference between two groups in other aspects. CONCLU- SION： Levosimendan has cardiac protection effect on patients under CABG with lower LVEF.