左西孟旦对脓毒症休克患者心功能影响的研究

Levosimendan on Cardiac Function in Patients with Septic Shock Impact Studies

目的观察左西孟旦对脓毒症休克患者心功能的影响。方法病例来源于2011年8月至2013年2月我院重症医学科的脓毒症休克患者,经过筛选后共有合格病例46例,其中对照组22例,试验组24例。两组均按照脓毒症治疗指南治疗,必要时使用升压药物,使MAP≥75mmHg。对照组采用多巴酚丁胺针5μg/(min kg),连续24h用药,最大使用量不超过40μg/(min kg)。试验组给予左西孟旦针(5%葡萄糖45mL+左西孟旦针12.5mg),12mL/h泵入10min,后以2mL/h静脉注射,持续24h。入组当天和第6天晨检测血肌钙蛋白、脑肭肽及PCT含量,行床边心脏超声评估心功能。计算各组治疗前后APACHEⅡ评分。记录ICU内全因病死率。结果两组患者治疗前心室射血分数(LVEF)、心脏指数(CI)无显著性差异(P>0.05),治疗后两组患者的CI和LVEF均有升高,肺动脉平均压(PAMP)则下降,以试验组治疗后比对照组同期改善明显(P<0.05)。两组患者治疗前的肌钙蛋白、脑钠肽无显著性差异(P>0.05),治疗后两组肌钙蛋白、脑钠肽均明显下降,以试验组下降明显(P<0.05)。治疗前及治疗后的降钙素原和APACH EⅡ组间比较无显著性差异(P>0.05)。两组的ICU内全因病死率比较无差异(P>0.05)。结论左西孟旦针能改善脓毒症休克患者心功能。

Objective Analyze the Cardiovascular effect of levosimendan on sepsis shock, patients. Methods 46 cases of sepsis shock patients admitted to the ICU department during 2011.8-2013.2 were included, they were randomly divided into control group （n=22） and treatment group （n=24）. The treatment group was received regular treatments plus levosimendan. The content of troponin, BNP and PCT were monitored onl and 6 day. LVEF, CI and PAMP were evaluated through cardiac ultrasound at different points. Results Two groups of patients before treatment ventricular ejection fraction （LVEF）, cardiac index （CI） was no significant difference （P〉0.05）, After treatment of the CI and LVEF had increased mean pulmonary artery pressure （PAMP） decreased in the experimental group than the control group after treatment period improved significantly （P〈0.05）. Two groups of patients before treatment troponin, brain natriuretic peptide was no significant difference （P〉0.05）, After treatment troponin, brain natriuretic peptide were significantly decreased in the experimental group decreased significantly （P〈0.05）, Before treatment and after treatment procalcitonin and APACHE Ⅱ groups showed no significant difference （P〉0.05）. Two sets of all-cause mortality in ICU was no significant difference （P〉0.05）.Condusion Levosimendan needle can improve heart function in patients with septic shock.