左西孟旦对感染性休克合并心功能不全患者心功能及预后的影响

The effects of levosimendan on the cardiac function and prognosis in septic shock with heart insufficiency

目的探讨左西孟旦对感染性休克合并心功能不全患者的心功能、炎症指标、血流动力学、脏器功能及预后的影响。方法纳入2019年3月-2021年12月于中山大学附属第一医院重症监护室(ICU)住院的感染性休克合并心功能不全患者65例,根据是否使用左西孟旦,将患者分为对照组(n=33)和用药组(n=32)。两组患者均给予感染性休克常规治疗,用药组在常规治疗基础上,予左西孟旦治疗。观察用药前及用药后72 h的N末端B型利钠肽原(NT-proBNP)、肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)、可溶性生长刺激表达基因2蛋白(ST2)和心脏型脂肪酸结合蛋白(HFABP)心功能指标,白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)、白介素6(IL-6)和肝素结合蛋白(HBP)炎症指标,心脏指数(CI)、体循环阻力指数(SVRI)和去甲肾上腺素用量血流动力学指标,肌酐(Cr)、总胆红素(TBIL)、急性生理学与慢性健康状况评分(APACHEⅡ)和全身感染相关器官功能衰竭评分(SOFA)器官功能指标,比较两组患者用药前基线水平和用药后各指标的差异。比较两组在3 d好转率、28 d死亡率及ICU住院天数等生存指标的差异。结果治疗后,与对照组比较,左西孟旦NT-proBNP、CK-MB、MYO和HFABP的下降率更显著。用药组vs.对照组下降率为NT-proBNP:-0.68(-0.90,-0.25)vs.-0.05(-0.19,2.80)(Z=2.23,P=0.026);CK-MB:-0.44(-0.81,0.17)vs.0.00(-0.24,0.37)(Z=2.35,P=0.019);MYO:-0.55(-0.74,-0.06)vs.-0.16(-0.46,0.00)(Z=2.10,P=0.036);HFABP:-0.53(-0.79,0.00)vs.-0.23(-0.52,0.12)(Z=1.98,P=0.048)。两组患者WBC、PCT、CRP、IL-6、HBP、CI、SVRI、去甲肾上腺素用量、肝肾功能、APACHEⅡ、SOFA评分、3 d好转率、28 d死亡率和ICU住院天数等结局指标差异无统计学意义(P均>0.05)。结论感染性休克并心功能不全患者在常规治疗基础上加用左西孟旦有利于改善心功能,但在改善炎症反应、血流动力学和器官功能,以及降低病死率方面,尚未观察到显著优势。

Objective To investigate the effects of levosimendan on cardiac function,inflammatory reactions,hemodynamics,organ function and prognosis in patients with septic shock with heart insufficiency.Methods A total of 65patients with septic shock accompanied by heart insufficiency admitted to ICU of the First Affiliated Hospital of Sun Yat-sen University from March 2019 to December 2021 were retrospectively analyzed.According to whether levosimendan was used or not,the patients were divided into control group(n=33)and levosimendan group(n=32).Both groups were given conventional therapy for septic shock,and the levosimendan group received levosimendan on the basis of conventional therapy.The N-terminal pro-B-type natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI),creatine kinase isoenzymeMB(CK-MB),myoglobin(MYO),growth stimulation expressed gene 2(ST2),human heart fatty acid binding protein(HFABP),white blood cell count(WBC),procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6),heparin-binding protein(HBP),cardiac index(CI),systemic vascular resistance index(SVRI),norepinephrine dosage,creatinine(Cr),total bilirubin(TBIL),acute physiology and chronic health evaluationⅡ(APACHE II)score and sequential organ failure assessment(SOFA)score before and 72 hours after treatment were observed.The differences of survival indicators such as the 3-day improvement rate,28-day mortality rate and ICU hospitalization days between the two groups were compared.Results Compared with the control group,the reduction rates of NT-proBNP,CK-MB,MYO and HFABP were more significant after levosimendan treatment.Decrate in the levosimendan group vs.control group:NT-proBNP:-0.68(-0.90,-0.25)vs.-0.05(-0.19,2.80)(Z=2.23,P=0.026);CK-MB:-0.44(-0.81,0.17)vs.0.00(-0.24,0.37)(Z=2.35,P=0.019);MYO:-0.55(-0.74,-0.06)vs.-0.16(-0.46,0.00)(Z=2.10,P=0.036);HFABP:-0.53(-0.79,0.00)vs.-0.23(-0.52,0.12)(Z=1.98,P=0.048).There was no significant difference in WBC,PCT,CRP,IL-6,HBP,CI,SVRI,norepinephrine dosage,liver and kidney function,APACHEⅡ,SOFA score,3-day improvement rate,28-day mortality rate and ICU hospitalization days.Conclusion Cardiac function was improved in patients with septic shock accompanied by heart insufficiency through the addition of levosimendan to standard treatment,but no significant advantage had been observed in improving inflammatory reaction,hemodynamics,organ function and reducing mortality.