比较左西孟旦与多巴胺在严重心脏瓣膜病合并心房颤动患者中的应用效果

Comparing curative effects of levosimendan and dopamine in patients with severe valvular heart disease complicated by atrial fibrillation

目的对比左西孟旦与多巴胺在严重心脏瓣膜病合并房颤患者手术中的应用效果。方法选取2010年10月~2013年10月在深圳市光明新区人民医院心胸外科行手术治疗的严重心脏瓣膜病合并房颤住院患者68例，其中男性43例，女性25例。随机分为A组和B组，各34例。两组患者均行心脏瓣膜置换术/成形术。A组患者在麻醉诱导后，立即应用左西孟旦注射液。B组患者在心脏复跳后应用多巴胺。两组用药均持续24h。记录两组主动脉阻断时间、体外循环时间、住院时间等。在围手术期各时刻（术前、术后6h、术后24h、术后48h）检测心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）、脑钠肽（BNP）水平。术前及术后5d，超声心动图测定左室射血分数（LVEF）。记录患者术后1个月内的手术并发症和不良反应情况。结果A组术后5d的LVEF值明显高于B组，[（43.0±2.3）%vs.（38.4±9.7）%]，差异有统计学意义（P＜0.05）。A组术后24h、48h的cTnI值分别为（0.40±0.17）μg/L、（0.16±0.06）μg/L，均显著低于B组的（0.57±0.18）μg/L、（0.39±0.11）μg/L，差异有统计学意义（P均＜0.05）。A组术后6h、24h、48h的BNP值分别为（936.8±270.6）ng/L、（750.7±305.4）ng/L、（608.4±183.3）ng/L，也显著低于B组的（1109.8±395.5）ng/L、（866.5±311.8）ng/L、（733.2±201.5）ng/L，差异有统计学意义（P均＜0.05）。A组术后的并发症发生率显著低于B组（20.59%vs.41.18%），差异有统计学意义（P＜0.05）。两组的不良反应发生率比较，差异无统计学意义（P＞0.05）。结论对行心脏瓣膜置换术/成形术的严重心脏瓣膜病合并房颤患者应用左西孟旦，较多巴胺，能有效增强心肌收缩，且术后并发症和不良反应少。

Objective To compare the application results of levosimendan and dopamine in patients with severe valvular heart disease complicated by atrial fibrillation (AF) during surgery. Methods The patients (n=68, male 43 and female 25) were chosen from the People’s Hospital of Guangming New District of Shenzhen City from Oct.2010 to Oct 2013, and randomly divided into group A and group B (each n=34). The patients in 2 groups were all given cardiac valve replacement/valvoplasty. Group A was given levosimendan injection immediately after anesthesia induction, and group B was given dopamine after heart resuscitation. After drug administration for 24 h, the aortic occlusion duration, duration of cardiopulmonary bypass (CPB) and length of hospital stay were recorded in 2 groups.The levels of cardiac troponin I (cTnI), creatine kinase MB (CK-MB) and brain natriuretic peptide (BNP) were detected at different time points (before surgery and 6 h, 24 h and 48 h after surgery). The changes of left ventricular ejection fraction (LVEF) was detected before and 5 d after surgery. The surgery complications and adverse reactions were recorded 1 m after surgery. Results LVEF was significantly higher in group A than that in group B [(43.0±2.3) % vs.(38.4±9.7) %] after surgery for 5 d (P<0.05). The value of cTnI was (0.40±0.17) μg/L after 24 h and (0.16±0.06) μg/L after 48 h in group A, and that was (0.57±0.18) μg/L after 24 h and (0.39±0.11) μg/L after 48 h in group B (all P<0.05). The value of BNP was (936.8±270.6) ng/L after 6 h, (750.7±305.4) ng/L after 24 h and (608.4±183.3) ng/L after 48 h in group A, and that was (1109.8±395.5) ng/L after 6 h, (866.5±311.8) ng/L after 24 h and (733.2± 201.5) ng/L after 48 h in group B (all P<0.05). The incidence of complications was significantly lower in group A than that in group B (20.59% vs. 41.18%, P<0.05), and the difference in incidence of adverse reactions had no statistical significance between 2 groups (P>0.05). Conclusion Levosimendan administrated during cardiac valve replacement/valvoplasty can effectively improve myocardial contract and reduce post-operation complications and adverse reactions compared with dopamine in patients with severe valvular heart disease complicated by AF.