左西孟旦在治疗体外循环心脏术后低心排血量综合征的临床应用

Clinical Study of Levosimendan in the Treatment of Low Cardiac Output Syndrome after Cardiopulmonary Bypass

目的 总结单中心小样本左西孟旦治疗体外循环心内直视下心脏术后低心排血量综合征(low cardiac output syndrome, LCOS)的临床疗效及生存分析。方法 随机选择2016年12月至2017年12月昆明医科大学附属延安医院心脏大血管外科体外循环心内直视下心脏术后LCOS患者36例,左室射血分数≤35%,在常规治疗疗效不佳情况下给予左西孟旦辅助治疗,剂量为0.1 μg/(kg·min),持续24 h,观察用药前后射血分数、心输出量、心肌酶学、肝肾功、Pro-BNP、累积生存率等指标的变化。结果 加用左西孟旦治疗后在提高心输出量及射血分数、降低Pro-BNP水平、提高累积生存率等指标方面差异有统计学意义(P < 0.05);左西孟旦对术后肝肾功能及心肌酶学的损伤差异无统计学意义(P > 0.05)。结论 对于体外循环心内直视下心脏术后并发LCOS的患者,在常规治疗效果不佳的基础上加用左西孟旦可有效改善患者的心功能。

Objective To summarize the clinical efficacy and survival analysis of single-center small sample levosimendan in the treatment of low cardiac output syndrome after cardiac surgery under cardiopulmonary bypass. Methods 36 cases with LCOS (LVEF≤35%) after cardiac surgery under cardiopulmonary bypass in our hospital from December 2016 to December 2017 were randomly selected in the research. Administering levosimendan in the treatment of poor efficacy of conventional therapy at a dose of 0.1 μg/kg/min for 24 hours. Moreover, the changes of ejection fraction, cardiac outputs, myocardial enzymology, liver and kidney functions, Pro-BNP, and cumulative survival rates were observed before and after treatment. Results There were statistically significant differences in the improvement of cardiac outputs and ejection fraction, reduction of Pro-BNP levels, and improvement of cumulative survival rates after treatment with levosimendan (P < 0.05). There were no statistically significant differences in the effects of levosimendan on postoperative liver and kidney functions and myocardial enzymology (P > 0.05). Conclusion For patients with postoperative cardiopulmonary bypass with LCOS cases, the addition of levosimendan can improve the heart function of patients with poor conventional treatment.