左西孟旦与多巴酚丁胺治疗脓毒症心肌病疗效对比

Effectiveness of levosimendan and dobutamine in treatment of septic cardiomyopathy

目的比较应用左西孟旦和多巴酚丁胺治疗脓毒症心肌病患者的临床效果。方法回顾性分析福建省立医院2018年1月至2020年12月收治的66例脓毒症心肌病患者,按照治疗方法的不同分为多巴酚丁胺组(n=32)和左西孟旦组(n=34),分别在常规治疗的基础上应用多巴酚丁胺和左西孟旦。分析治疗前后2组患者的N末端B型利尿钠肽原(N-terminal pro-brain natriuretic peptide,NT-proBNP)、肌钙蛋白I、乳酸水平、氧合指数、住院时间、住院死亡率、去甲肾上腺素总剂量以及不良反应情况。结果治疗前,两组患者的NT-proBNP、肌钙蛋白I、乳酸、氧合指数差异无统计学意义(P>0.05);治疗后,两组患者的NT-proBNP、乳酸、肌钙蛋白I水平比治疗前降低,氧合指数比治疗前升高(均P<0.05)。治疗后,左西孟旦组患者的NT-proBNP、肌钙蛋白I、乳酸水平、住院时间和去甲肾上腺素总剂量比多巴酚丁胺组低,氧合指数比多巴酚丁胺组高(均P<0.05);与多巴酚丁胺组相比,左西孟旦组心律失常发生率下降,差异有统计学意义(P<0.05)。两组死亡率差异无统计学意义(P>0.05)。结论左西孟旦与多巴酚丁胺相比,能更好地改善脓毒症心肌病患者的心功能,稳定血流动力学,减少住院时间,但无法降低住院死亡率。

Objective To compare the effectiveness of levosimendan and dobutamine in patients with septic cardiomyopathy.Methods Data of 66 patients with septic cardiomyopathy admitted to our hospital from January 2018 to December 2020 were retrospectively reviewed.The patients were divided into dobutamine group and levosimendan group according to different treatments.A total of 32 cases in the dobutamine group received dobutamine on the basis of conventional treatment;34 cases in the levosimendan group received levosimendan on the basis of conventional medication.The N-terminal pro-brain natriuretic peptide(NT-proBNP),troponin I,lactate,oxygenation index,length of hospitalization,hospital mortality,total norepinephrine dose and adverse reactions of the two groups before and after treatment were analyzed.Results Before treatment,there was no statistically significant difference in NT-proBNP,troponin I,lactate,and oxygenation index between the two groups(P>0.05).After treatment,the NT-proBNP,lactate,and troponin I levels reduced,while oxygenation index increased in both groups,and the differences were statistically significant(all P<0.05).The NT-proBNP,troponin I,lactate levels,and total norepinephrine dose in levosimendan group were lower than those in dobutamine group.Length of hospitalization was shorter than that in dobutamine group.However,the oxygenation index were higher in levosimendan group than those in dobutamine group after treatment(all P<0.05).Compared with the dobutamine group,the incidence of arrhythmia in the levosimendan group significantly decreased(P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusion Levosimendan is more effective than dobutamine in improving the heart function of patients with septic cardiomyopathy,stabilizing hemodynamics,and reducing the hospital stay and the incidence of arrhythmia,but it cannot reduce the hospital mortality.