左西孟旦对冠状动脉旁路移植术合并瓣膜置换术患者的肾脏保护作用

Renal protection of levosimendan in patients undergoing coronary artery bypass grafting combined with valve replacement

目的探讨左西孟旦应用于冠状动脉旁路移植术合并瓣膜置换术患者对肾脏的保护作用。方法选取2016年1-12月于首都医科大学附属北京安贞医院择期行冠状动脉旁路移植术合并瓣膜置换术的严重心功能受损(左心室射血分数低于50%)患者30例,根据随机数字表法分为观察组和对照组,各15例。观察组麻醉诱导后给予左西孟旦静脉泵注,对照组术中除常规应用血管活性药物外无特殊药物处理。于术前、术后6、12、24、48、72 h采集患者血液标本,检测乳酸、尿素氮、肌酐水平,并记录术中及术后相应时间的尿量。记录患者术后24 h引流量、机械通气时间、重症监护时间及住院时间。结果观察组术中、术后6、12、24 h时尿量明显多于对照组[(1 713±458)ml比(1 257±489)ml、(1 812±442)ml比(1 192±339)ml、(2749±696)ml比(1 793±329)ml、(4036±805)ml比(3 186±615)ml](P<0.05);术后12、24、48 h时血乳酸水平明显低于对照组[(4.10±2.28)mmol/L比(6.18±3.45)mmol/L、(2.10±1.05)mmol/L比(4.60±1.86)mmol/L、(1.90±0.95)mmol/L比(4.90±2.94)mmol/L];术后6、12、24 h时血尿素氮水平明显低于对照组[(6.5±1.4)mmol/L比(15.5±7.4)mmol/L、(7.3±1.5)mmol/L比(15.5±7.4)mmol/L、(7.6±1.8)mmol/L比(9.7±2.1)mmol/L];术后24、48 h时血肌酐水平明显低于对照组[(92±14)μmol/L比(106±15)μmol/L、(93±25)μmol/L比(107±32)μmol/L],差异均有统计学意义(均P<0.05)。2组患者术后24 h引流量、机械通气时间、重症监护时间、住院时间差异均无统计学意义(均P>0.05)。结论左西孟旦可以减轻冠状动脉旁路移植术合并瓣膜置换术患者围术期肾脏损伤程度。

Objective To explore the renal protection of levosimendan in patients undergoing coronary artery bypass grafting combined with valve replacement. Methods Thirty patients with severe cardiac dysfunction（left ventricular ejection fraction＜50%） undergoing coronary artery bypass grafting combined with valve replacement from January to December 2016 in Beijing Anzhen Hospital, Capital Medical University were randomly divided into observation group and control group, with 15 cases in each group. The observation group had intravenous infusion of levosimendan after anesthesia induction; the control was treated with routine vasoactive agents. Levels of blood lactate, urea nitrogen and creatinine were tested before and 6, 12, 24, 48, 72 h after operation. Urine volume was recorded during and after operation. Postoperative 24 h drainage volume, mechanical ventilation time, intensive care time stay time and hospital stay time were recorded. Results Urine volume during operation and 6, 12, 24 h after operation in observation group were significantly more than those in control group［（1 713±458）ml vs （1 257±489）ml, （1 812±442）ml vs （1 192±339）ml, （2 749±696）ml vs （1 793±329）ml, （4 036±805）ml vs （3 186±615）ml］（P＜0.05）. Levels of blood lactate 12, 24, 48 h after operation in observation group were significantly lower than those in control group［（4.10±2.28）mmol/L vs （6.18±3.45）mmol/L, （2.10±1.05）mmol/L vs （4.60±1.86）mmol/L, （1.90±0.95）mmol/L vs （4.90±2.94）mmol/L］（P＜0.05）. Levels of blood urea nitrogen 6, 12, 24 h after operation in observation group were significantly lower than those in control group［（6.5±1.4）mmol/L vs （15.5±7.4）mmol/L, （7.3±1.5）mmol/L vs （15.5±7.4）mmol/L, （7.6±1.8）mmol/L vs （9.7±2.1）mmol/L］（P＜0.05）. Levels of serum creatinine 24, 48 h after operation in observation group were significantly lower than those in control group［（92±14）μmol/L vs （106±15）μmol/L, （93±25）μmol/L vs （107±32）μmol/L］（P＜0.05）. Postoperative 24 h drainage volume, mechanical ventilation time, intensive care time and hospital stay time had no significant differences between groups（P＞0.05）. Conclusion Levosimendan can help reduce renal injury in patients undergoing coronary artery bypass grafting and valve replacement.