左西孟旦对脓毒性心肌病患者急性肾损伤的疗效评价

The effects of levosimendan on acute kidney injury in patients with septic cardiomyopathy

目的探讨左西孟旦治疗对脓毒性心肌病患者肾功能的影响。方法回顾性入选2018年5月至2020年4月期间于南通大学附属医院急诊监护病房住院诊断为脓毒性心肌病,接受脉波指示剂连续心输出量监测(PiCCO)和床旁超声心动图及肾脏超声检查患者,分为左西孟旦组(常规治疗基础上联合左西孟旦)和对照组(常规治疗),以PiCCO仪器测量心脏指数(cardiac index,CI)等血流动力学指标,床旁超声心动图测量左心室射血分数(LVEF)等指标,床旁肾脏超声评估肾血流分级及肾阻力指数(RRI),评价治疗后7天时血流动力学指标变化及心功能、肾功能转归,比较两组患者住院期间急性肾损伤(AKI)发生率及因AKI接受持续性肾脏替代治疗(CRRT)的比例、时长,并随访两组患者28天时的临床转归。结果共入选患者56例,左西孟旦组25例,对照组31例。两组患者基线特征差异无统计学意义(P均>0.05)。治疗7天后,左西孟旦组患者的CI高于对照组患者[5.7(4.6,7.4)L·min^(-1)·m^(-2)比4.5(3.5,5.3)L·min^(-1)·m^(-2),P=0.004],LVEF水平也高于对照组患者[51.0(39.0,57.0)%比40.0(31.0,49.0)%,P=0.015],肾血流分级高于对照组患者(P=0.020),RRI低于对照组患者[0.62(0.56,0.69)比0.67(0.62,0.74),P=0.034]。住院期间两组患者发生AKI的比例及需要CRRT的比例差异无统计学意义(P均>0.05);但左西孟旦组患者因AKI接受CRRT的治疗时间显著短于对照组患者(56h比73h,P=0.009)。左西孟旦组与对照组患者随访28天的死亡率差异无统计学意义(24.0%比22.6%,P=1.000)。结论脓毒性心肌病患者在常规治疗基础上应用左西孟旦可以改善心功能和肾血流,从而促进肾功能改善,促进接受CRRT治疗的脓毒性心肌病合并AKI患者顺利撤机。

Objective To investigate the effects of levosimendan on renal function in patients with septic cardiomyopathy.Methods Patients admitted to the Emergency Intensive Care Unit(EICU)of Affiliated Hospital of Nantong University from May 2018 to April 2020 diagnosed with septic cardiomyopathy assessed by pulse-indicator continuous cardiac output(PiCCO)and bedside echocardiograpy and renal ultrasound were retrospectively enrolled and divided into levosimendan group(combined levosimendan with traditional treatment)and control group(traditional treatment).The cardiac index(CI)and other hemodynamic indicators were measured by the PiCCO instrument,the left ventricular ejection fraction(LVEF)and other indicators were measured by bedside echocardiography,and renal blood flow grading and renal resistance index(RRI)were evaluated by bedside renal ultrasound.Changes of hemodynamic indexes and cardiac and renal function at 7 days after treatment were evaluated.The incidence of acute kidney injury(AKI)and the proportion and duration of patients receiving continuous renal replacement therapy(CRRT)for AKI during hospitalization were compared between the two groups,and the clinical outcomes of patients were followed up at 28 days.Results A total of 56 patients were enrolled,including 25 patients in levosimendan group and other 31 patients in control group.There was no significant difference in baseline characteristics between the two groups(all P>0.05).After 7 days of treatment,compared with the control group,in the levosimendan group,CI was significantly higher[4.5(3.5,5.3)L·min^(-1)·m^(-2)vs.5.7(4.6,7.4)L·min^(-1)·m^(-2),P=0.004],the LVEF was also significantly higher[40.0(31.0,49.0)%vs.51.0(39.0,57.0)%vs,P=0.015],the renal blood flow grading was higher(P=0.020),and the RRI was significantly lower[0.67(0.62,0.74)vs.0.62(0.56,0.69),P=0.034].There was no significant difference in the proportion of AKI and the proportion of CRRT required between the two groups during hospitalization(all P>0.05);However,the duration of CRRT treatment for AKI in levosimendan group was significantly shorter than that in the control group(56h vs.73h,P=0.009).There was no significant difference in mortality between levosimendan group and control group at 28 days of follow-up(24.0%vs.22.6%,P=1.000).Conclusion In patients with septic cardiomyopathy,levosimendan treatment can improve cardiac function and renal blood flow,and then promote renal function recovery and successful withdrawal of CRRT for those complicating AKI on the treatment of CRRT.