左西孟旦与多巴酚丁胺对脓毒症休克患者心肌抑制影响的对比观察

Comparative Observation of Effects of Levosimendan and Dobutamine on Myocardial Inhibition in Patients with Septic Shock

目的:探讨脓毒症休克患者分别应用左西孟旦(LEV)与多巴酚丁胺(Dob)对心肌抑制的改善效果。方法:选取我院2014年7月~2016年6月收治的63例脓毒症休克患者,依照随机数字表法分为观察组(31例)和对照组(32例)。两组均给予常规基础治疗,在其基础上,对照组予以Dob治疗,观察组给予LEV治疗。记录比较两组治疗前后左室收缩期末容积指数(LVESI)、左室舒张期末容积指数(LVEDI)及左心射血分数(LVEF)、心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,预后情况。结果:与治疗前比较,两组治疗7 d时LVESI、LVEDI、LVEF,均显著改善(P<0.01);且观察组改善程度较对照组相比,更为显著(P<0.01);两组治疗7d时血清cTnI、BNP水平和APACHEⅡ评分,均显著低于治疗前(P<0.01);与对照组治疗7d时相比,观察组心肌损伤指标及APACHEⅡ评分改善程度均更为显著(P<0.01);观察组28d生存率为54.8%略高于对照组的50.0%,但组间差异无统计学意义(P>0.05)。结论:脓毒症休克患者应用LEV更有利于提高心脏功能,稳定病情,改善心肌抑制,具有较高临床推广价值。

Objective： To investigate the effect of levosimendan（Lev） and dobutamine（Dob） on the improvement ofmyocardial inhibition in patients with septic shock. Methods： 63 patients with septic shock in our hospital from July2014 to June 2016 were selected as the research object. According to the random number table method, patients wererandomly divided into the observation group of 31 cases and the control group of 49 cases. Patients of two groups wereboth given conventional treatment. On its basis, patients in the control group were treated with Dob. Patients in theobservation group were treated with LEV. The left ventricular end systolic volume index（LVESI）, left ventricular enddiastolic volume index（LVEDI） and left ventricular ejection fraction（LVEF）, cardiac troponin Ⅰ（cTnI）, brain natriureticpeptide（BNP） and chronic health evaluation Ⅱ and acute physiology score（APACHE Ⅱ） as well as the prognosis of thetwo groups before and after treatment were compared. Results： Compared with before treatment, when treated 7 d, theLVESI, LVEDI, LVEF of the two groups were significantly improved（P〈0.01）. The improvement degree in theobservation group compared with the control group was more significantly（P〈0.01）. After 7 d of treatment, the serumcTnI, BNP level and APACHE score were significantly lower than those before treatment（P〈 0.01）. Compared with thecontrol group, after 7d of treatment, the myocardial damage index and APACHE score of the observation group wereimproved more significantly（P〈0.01）. The survival rate after 28 d in the observation group is slightly higher than that ofthe control group（54.8% vs 50%）, but there was no significant difference between the groups（P〉0.05）. Conclusion：LEV treatment to patients with septic shock is more conducive to improve the heart function, stable condition, improvemyocardial suppression, which has a high clinical value.