左西孟旦对冠状动脉旁路移植术患者围术期心肾功能的影响

Effect of levosimendan on cardiac and renal function after coronary artery bypass grafting

目的观察左西孟旦治疗对于冠状动脉旁路移植术(CABG)患者围术期心肾功能的影响。方法入选2019年10月至2021年5月在中山大学附属第一医院心外科行CABG的患者, 依据随机数字表分成左西孟旦组和对照组。患者术后留置Swan-Ganz导管, 收集记录术毕给药前、术后24 h、72 h肺毛细血管楔压(PCWP)、平均肺动脉压(mPAP)、心输出量(CO)、N末端B型利钠肽原(NT-proBNP)、肌酸激酶同工酶(CK-MB)、行超声心动图检查记录左心室射血分数(LVEF);记录术前、术后24 h、72 h、5 d的血尿素氮(BUN)、肌酐清除率(Ccr)、胱抑素C(Cys-C);术后ICU住院时间、术后住院时间及发生急性肾损伤(AKI)例数。结果共有68例患者纳入分析, 左西孟旦组32例。对照组36例, 两组基线资料比较差异均无统计学意义(P均>0.05)。心脏功能相关指标方面, 两组患者术前PCWP、mPAP、CO、CK-MB及LVEF差异均无统计学意义(P均>0.05);术后两组患者PCWP、mPAP、NT-proBNP及CK-MB呈下降趋势, CO及LVEF均呈上升趋势;左西孟旦组在术后24 h、72 h的mPAP、NT-proBNP及CK-MB均低于对照组, CO、LVEF均高于对照组, 差异均有统计学意义(P均<0.05)。肾脏功能指标方面, 两组患者术前BUN、Ccr及Cys-C差异均无统计学意义(P均>0.05), 术后BUN及Cys-C呈现先升高后降低, Ccr则先降低后升高;左西孟旦组术后24 h、72 h、5 d时的BUN均低于对照组(P均<0.05), 而术后24 h、72 h时的Ccr、Cys-C均高于对照组(P均<0.05)。左西孟旦组术后ICU 住院时间及术后住院时间均短于对照组, 差异均有统计学意义(P均<0.05)。结论左西孟旦可有效改善CABG患者围术期心肾功能, 减少术后ICU住院时间和术后住院时间。

Objective To evaluate the effect of levosimendan on cardiac and renal function after coronary artery bypass grafting(CABG).Methods Patients underwent CABG in the First Affiliated Hospital of Sun Yat-sen University from October 2019 to May 2021 were selected and divided into levosimendan group and control group using random number table method.Swan-Ganz catheter was retained in all patients after the surgery.Pulmonary capillary wedge pressure(PCWP),mean pulmonary artery pressure(mPAP),cardiac output(CO),N terminal-pro B type natriuretic peptide(NT-pro BNP),creatine kinase isozymes(CK-MB),left ventricular ejection fraction(LVEF)detected by echocardiography were recorded before operation,24 h,72 h after operation.Blood urea nitrogen(BUN),creatinine clearance rate(Ccr),cystatin C(Cys-c)were recorded before operation,24 h,72 h and 5d after operation;postoperative length of stay(LOS)in ICU,postoperative LOS in hospital and number of cases suffered from acute kidney injury(AKI)were recorded.Results A total of 68 patients were enrolled of whom 32 for levosimendan group and other 36 for control group.There were no significant differences in baseline characteristics between these two groups.As for cardiac function related parameters,there were no significant differences in PCWP,mPAP,CO,CK-MB and LVEF(all P>0.05)befor operation.After operation,PCWP,mPAP,NT-proBNP and CK-MB decreased,CO and LVEF increased in both groups.Moreover,the mPAP,NT-proBNP and CK-MB in the levosimendan group at 24 h and 72 h after surgery were significantly lower than those in the control group,while CO and LVEF were significantly higher than those in the control group(all P<0.05).Regarding renal function related parameters,there were no significant differences in BUN,Ccr and Cys-C before operation(all P>0.05).After operation,BUN and Cys-C increased first and then decreased,while Ccr decreased first and then increased in two groups.BUN was significantly lower in the levosimendan group than those in the control group at 24 h,72 h and 5 d after operation(all P<0.05),while Ccr were higher and Cys-c were lower significantly in the levosimendan group than those in the control group at 24 h and 72 h after operation(all P<0.05).Postoperative LOS in ICU and in hospital in the levosimendan group were significantly shorter than those in the control group(all P<0.05).Conclusion Levosimendan can effectively improve the postoperative cardiac and renal function of patients with CABG,reduce the postoperative LOS in ICU and in hospital.