左西孟旦对低心排量心力衰竭患者的血流动力学影响

Effects of Levosimendan on haemodynamics in heart failure patients with low cardiac output

目的 观察左西孟旦对低心排量心力衰竭(心衰)患者的血流动力学的影响. 方法选择2009年7月至2016年5月,收入我院外科重症监护病房的低心排量心衰患者27例,予以左西孟旦12.5 mg ,在24 h内持续静脉输注(0.1~0.2 μg· kg -1· min-1) ,用脉搏指示连续心排血量(PICCO )监测用药前以及用药24 h 、4 d 、7 d后血流动力学参数的变化. 结果 用药前与用药24 h 、4 d 、7 d后血流动力学参数比较,收缩压、舒张压、心率、全心舒张末期容积指数(GEDI)差异无统计学意义.与用药前比较,中心静脉(6.35 ± 2.31)mmHg(1 mmHg=0.133 kPa)比(6.81 ± 2.03) mmHg、(5.92± 2.23)mmHg、(8.34± 2.87)mmHg(P= 0.001),外周血管阻力指数(2 170± 410.9)dyn·s-1·cm -5·m -2、(2 062 ± 340.6)dyn·s-1·cm -5·m -2、、(1 960 ± 380.2)dyn·s-1 ·cm -5·m -2比(2 682 ± 388.9)dyn· s-1· cm -5· m -2(P= 0.003)、血管外肺水指数(6.60 ± 2.66)ml/kg 、(5.92 ± 2.88)ml/kg 、(5.46 ± 2.52)ml/kg 、(8.90 ± 2.45)ml/kg(P<0.01) ,B型利钠肽下降(P<0.01) ,心脏指数、心功能指数、每搏量指数增高(P<0.05或 P<0.01). 结论 单次剂量左西孟旦静脉输注,能增加低心排患者的心排量,降低外周血管阻力,并维持较长的时间.

Objective To investigate effects of Levosimendan on hemodynamics in heart failure patients with low cardiac output. Methods A total of 27 heart failure patients with low cardiac output were recruited in the surgical intensive care unit (SICU)of Beijing Hospital from July 2009 to May 2016. All patients were treated with continuous intravenous infusion of Levosimendan 12.5 mg within 24 h at a rate of 0.1~0.2 μg· kg -1·min-1. Hemodynamic variables were monitored by pulse-indicated continuous cardiac output(PICCO)at baseline ,24 h ,4 d and 7 d after infusion. Results There were no significant differences in systolic blood pressure(SBP) ,diastolic blood pressure(DBP) ,heart rate(HR)and global end diastolic volume index (GEDI)as comparing baseline with 24 h ,4 d and 7 d after infusion of levosimendan. The significant differences were found in central venous pressure (CVP) ,systemic vessel resistance index (SVRI) , extravascular lung water index (EVLWI ) among baseline versus 24 h ,4 d and 7 d after infusion of levosimendan[(8.34± 2.87)mmHg vs.(6.35± 2.31),(6.81± 2.03),(5.92± 2.23)mmHgforCVP ,(2 682.0 ± 388.9)dyn·s-1·cm -5·m-2vs. (2 170.0 ± 410.9) ,(2 062.0 ± 340.6 ) ,(1 960.0 ± 380.2 )dyn ·s-1·cm-5·m-2for SVRI ,(8.90 ± 2.45)ml/kg vs. (6.60 ± 2.66) ,(5.92 ± 2.88) ,(5.46 ± 2.52) ml/kg for EVLWI ,P=0.001 ,0.003 or<0.01 ,respectively].As compared with hemodynamic variables at baseline ,brain natriuretic peptide levels were decreased ,and cardiac index ,cardiac function index and stroke volume index were increased at 24 h ,4 d and 7 d after infusion of Levosimendan (P<0.01 ,0.05 or 0.01 , respectively ). Conclusions A single-dose intravenous infusion of Levosimendan can increase cardiac output and decrease systemic vascular resistance in heart failure patients with low cardiac output ,which maintain quite a long time.