左西孟旦治疗冠脉搭桥术后低心排综合征并急性肾损伤20例临床评价

Levosimendan for Treating Low Cardiac Output Syndrome with Acute Kidney Injury after Coronary Artery Bypass Grafting in 20 Cases

目的观察左西孟旦治疗冠脉搭桥术后低心排综合征合并急性肾损伤的临床疗效。方法将40例冠脉搭桥术后低心排综合征合并急性肾损伤患者随机分为对照组和观察组,各20例。对照组患者采用多巴胺处理,观察组患者采用左西孟旦注射液处理。检测两组患者术前及术后24 h左室射血分数(LVEF)、左室短轴缩短率(LVFS)以评价心排出量,同时观察血肌酐(Cr)、血胱抑素C(Cys C)水平变化,计算肾小球滤过率(GFR)差异以评价肾功能损害程度,观察两组患者药品不良反应发生情况。结果治疗后,两组患者LVEF及LVFS较治疗前均明显提高(P<0.05),且观察组患者改善程度更显著(P<0.05);两组患者Cr及Csy C较治疗前均明显上升(P<0.05),且观察组Csy C上升程度更显著(P<0.05);两组患者GFR较治疗前显著降低(P<0.05),且观察组下降程度更显著(P<0.05);对照组不良事件发生率显著高于观察组(P<0.05)。结论左西孟旦注射液疗效确切、安全,能显著改善冠脉搭桥术后心排出量,同时能显著降低低心排综合征对肾功能的急性损害。

Objective To observe the clinical efficacy of levosimendan in treating low cardiac output syndrome with acute kidney injury after coronary artery bypass grafting. Methods 40 cases of coronary artery bypass grafting patients with postoperative low cardiac output syndrome complicated with acute renal injury were randomly divided into control group and observation group, 20 cases in each group. The control group was treated with dopamine treatment, and the observation group was treated with levosimendan injection treatment. The left ventricular ejection fraction（ LVEF）,left ventricular fractional shortening（ LVFS） in evaluation of cardiac output of the two groups were observed before and after the operation; at the same time, the serum creatinine（ Cr）, Cystatin C（ Cys C） level, calculated glomerular filtration rate（ GFR） were observed to evaluate the renal function damage degree. In addition,the adverse drug reactions were observed in two groups during the process of treatment. Results After treatment, the LVEF and LVFS levels of the two groups were significantly improved than before treatment（ P〈0. 05）,and the improvement of the observation group was more significantly than that of the control group（ P〈0. 05）; the levels of Cr and Csy C were significantly increased（ P〈0. 05）,and the Csy C of the observation group increased more significantly than that in control group（ P〈0. 05）; the GFR levels of the two groups were significantly decreased（ P〈0. 05）, and the observation group decreased more obviously than the control group（ P〈0. 05）. The incidence of adverse events in the control group was significantly higher than the observation group（ P〈0. 05）. Conclusion The levosimendan treatment is safe and exact,can significantly improve the cardiac output after coronary artery bypass grafting,and can significantly reduce the low cardiac output syndrome of acute injury of renal function.