左西孟旦与多巴酚丁胺及与米力农治疗脓毒症心肌损伤的有效性及安全性评价

Efficacy and safety evaluation of levosimendan,dobutamine and milrinone in the treatment of septic myocardial injury

目的探讨左西孟旦与多巴酚丁胺、米力农治疗脓毒症心肌损伤的有效性及安全性。方法选取脓毒症心肌损伤患者84例作为研究对象,按照随机数字表法分为左西孟旦组、多巴酚丁胺组、米力农组,各28例,对比总有效率、可溶性髓样细胞触发性受体1(soluble myeloid cell trigger receptor-1,sTREM-1)、可溶性白细胞分化抗原14(soluble cluster of differentiation antigen 14,sCD14)、可溶性白细胞分化抗原163(soluble cluster of differentiation antigen 163,sCD163)、心肌肌钙蛋白(cardiac troponin I,cTnI)、脑肽钠(brain natriupeptide,BNP)、左心室舒张末期容积指数(left ventricular end-diastolic volume index,LVEDVI)、左心室收缩末期容积指数(left ventricular end-systolic volume index,LVESVI)、左心室射血分数(left ventricular ejection fraction,LVEF)及不良反应。结果左西孟旦组的总有效率高于多巴酚丁胺组、米力农组(P<0.05)。单因素方差比较显示,治疗前,3组sTREM-1、sCD14、sCD163、cTnI、BNP、LVEF、LVEDVI、LVESVI比较,差异无统计学意义(P>0.05);3组治疗后sTREM-1、sCD14、sCD163、cTnI、BNP、LVEF、LVEDVI、LVESVI比较,差异有统计学意义(P<0.05);两两比较显示,左西孟旦组sTREM-1、sCD14、sCD163、cTnI、BNP、LVEDVI、LVESVI低于多巴酚丁胺组、米力农组,而LVEF高于多巴酚丁胺组、米力农组(P<0.05)。左西孟旦组与多巴酚丁胺组的不良反应总发生率低于米力农组(P<0.05);左西孟旦组与多巴酚丁胺组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论左西孟旦治疗脓毒症心肌损伤效果优于多巴酚丁胺与米力农,且安全性高,无严重不良反应。

Objective To investigate the efficacy and safety of levosimendan,dobutamine and milrinone in the treatment of septic myocardial injury.Methods In total,84 patients with septic myocardial injury were selected and divided into levosimendan group,dobutamine group,and milrinone group according to the random number table method,with 28 patients in each group.Total effective rate,soluble myeloid cell trigger receptor-1(sTREM-1),soluble cluster of differentiation antigen 14(sCD14),soluble cluster of differentiation antigen 163(sCD163),cardiac troponin I(cTnI),brain natriupeptide(BNP),left ventricular end-diastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI),left ventricular ejection fraction(LVEF)and adverse reactions were compared in the three groups.Results The total effective rate of levosimendan group was higher than that of dobutamine group and milrinone group(P<0.05).One-way analysis of variance showed that before treatment,there was no significant difference in sTREM-1,sCD14,sCD163,cTnI,BNP,LVEF,LVEDVI,and LVESVI among three groups(P>0.05).The comparison of sTREM-1,sCD14,sCD163,cTnI,BNP,LVEF,LVEDVI,and LVESVI was statistically significant among three groups(P<0.05).Comparison between two groups showed that sTREM-1,sCD14,sCD163,cTnI,BNP,LVEDVI,and LVESVI in levosimendan group were lower than those in dobutamine group and milrinone group,while LVEF was higher than that of dobutamine group and milrinone group(P<0.05).The total incidence of adverse reactions in levosimendan group and dobutamine group was lower than that in milrinone group(P<0.05),which,however,were not significantly different between levosimendan group and dobutamine group(P>0.05).Conclusion Levosimendan is more effective than dobutamine and milrinone in the treatment of sepsis myocardial injury,with good safety and no serious adverse reactions.