左西孟坦在术前低射血分数体外循环冠状动脉旁路移植术疗效的小样本观察

Observe curative effect of small sample of levosimendan in low ejection fraction of off-pump coronary artery bypass grafting before operation

目的探讨体外循环冠状动脉旁路移植术(CABG)术前使用左西孟坦治疗对严重左心功能不全患者的影响。方法选择52例CAGB患者作为研究对象,其中28例为左西孟坦治疗组,24例未接受左西孟坦治疗作为对照组。左西孟坦治疗组患者于术前24 h接受左西孟坦治疗(负荷剂量10μg/kg并维持0.1μg·kg-1 min-1的剂量泵注24 h)。结果左西孟坦治疗组与对照组相比,术前心输出量、心脏指数、术后难脱离体外循环的发生率、死亡率、低心排的发生率,差异均有统计学意义(P<0.05)。与对照组相比,左西孟坦治疗组患者对强心药、血管收缩剂及主动脉内球囊反博泵的需求降低,差异均有统计学意义(P<0.05)。左西孟坦在术前的主要不良反应为低血压1例(3.6%)、头痛,与其它扩血管剂同时使用,可增加低血压的发生率。结论对于行体外循环冠脉搭桥术的严重左心功能不全(射血分数<35%)患者,术前使用左西孟坦可以降低死亡率、低心排的发生,减少对强心药、血管收缩剂和主动脉内球囊反博泵的需求及提高患者对手术的耐受性。

Objective To investigate the use of extracorporeal circulation of coronary artery bypass grafting （CAGB） preoperative levosimendan therapy on patients with severe left ventricular dysfunction effects. Methods 52 CAGB patients were chosen as the research object （28 levosimendan treatment group, 24 in the treatment group who did not receive levosimendan） from Sep. 2009 to Sep. 2012. The proposed line pump coronary artery bypass grafting in severe left ventricular dysfunction （ejection fraction〈35% ） of patients in the 24 hours before surgery levosimendan admitted to hospital for treatment group （loading dose 10 μg/kg and maintain 0.1 μg· kg^-1· min^-1 infusion dose of 24 hours） and levosimendan not receiving treatment groups. Results Levosimendan treated patients who did not receive levosimendan treatment group compared to the preoperative cardiac output and rapid cardiac index, postoperative incidence of difficult than weaned from CPB, the mortality rate, the incidence of low cardiac output, the differences were statistically significant （P〈0.05）. Levosimendan patients treated for cardiac drugs, a vasoconstrictor and intra-aortic balloon pump lower demand,the differences were statistically significant （P〈0.05）.In the preoperative levosimendan major adverse transfusion reactions were hypotension one case （3.6%）, headache, and other vasodilator agents used simultaneously, can increase the incidence of hypotension. Conclusion CABG in severe left ventricular dysfunction （ejection fraction〈35%） in patients with preoperative levosimendan can reduce mortality and the incidence of low cardiac drugs on cardiac and vascular shrinkage agents and intraaortic balloon pump counterpulsation demand and improve patient tolerance of surgery.