左西孟旦在重症瓣膜性心脏病外科手术心肌缺血预处理中的应用

Application of Levosimendan in myocardial ischemia preconditioning in patients with severe valvular heart disease

目的研究左西孟旦对重症瓣膜性心脏病外科手术治疗缺血预处理的心肌保护作用,探讨减少心脏外科手术缺血再灌注损伤的优化心肌保护策略。方法回顾性分析东莞康华医院心外科2017年1~5月收治的40例重症瓣膜性心脏病患者,按治疗方法分成左西孟旦缺血预处理组(A组,20例)和未使用左西孟旦组(B组,20例),A组于开胸开始至主动脉阻断前10 min,总长约30 min,外周静脉持续泵入左西孟旦,剂量为6~12μg/kg。观察两组患者术前及主动脉开放后6、18、48 h肌酸激脢(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)、血乳酸值(BLA)水平。采用无创血流动力学检测术前及术后1、3、7 d左心室射血分数(LVEF)、左室每搏做功指数(LVSWI)、心脏指数(CI)等变化。记录两组患者手术后并发症(肾功能损伤及心律失常、低心排综合征等)发生情况。结果两组患者主动脉开放后各时间点CK-MB、cTnⅠ、BLA、LVEF、CI及LVSWI比较,差异有统计学意义(P<0.05)。A组并发症发生率低于B组(P<0.05)。结论重症瓣膜性心脏病患者行外科手术治疗时应用左西孟旦进行心肌缺血预处理,这种优化心肌保护策略可以起到减少心肌缺血再灌注损伤程度,从而降低围术期的并发症发生率,明显提高心脏外科手术患者的治疗效果。

Objective To study the protective effect of Levosimendan on ischemic preconditioning in patients with severe valvular heart disease,in order to explore the optimal myocardial protection strategy to reduce ischemia-reperfusion injury in cardiac surgery.Methods From January to May in 2017,40 patients with severe valvular heart disease from Department of Cardiac Surgery in Dongguan Kanghua Hospital were retrospectively andlyzed,and they were divided into two groups according to treatment:Levosimendan ischemic preconditioning group(group A,20 cases)and untreated Levosimendan group(group B,20 cases).During the onset of thoracotomy and 10 minutes before the occlusion of the aorta,the total length was about 30 minutes,the peripheral vein of group A was continuously pumped into Levosimendan at a dose of 6-12μg/kg.the changes of myocardial enzymes(CK-MB),troponinⅠ(cTnⅠ)and blood lactic acid(BLA)were measured at 6,18 h and 48 h after aortic off-clamping in the two groups.LVEF,LVSWI,CI were recorded before and 1,3,7 d after operation.The complications of renal injury and arrhythmia and low cardiac output were recorded.Results There were statistically significant differences of CK-MB,cTnⅠ,BLA,LVEF,CI,LVSWI levels between the two groups at different time points after aortic off-clamping(P<0.05).The incidence of complications in group A was lower than that in group B(P<0.05).Conclusion Myocardial ischemic preconditioning with Levosimendan in patients with severe valvular heart disease can be used to reduce the degree of myocardial ischemia and reperfusion injury and the complications of perioperative period,which can improve the treatment of patients with cardiac surgery.