左西孟旦对心衰恶病质患者心脏移植结果的影响

Effect of levosimendan on outcome of heart transplantation in patients with heart failure cachexia

目的观察左西孟旦对心衰恶病质患者心脏移植结果的影响。方法分析2014年1月至2022年10月实施的心脏移植患者158例, 根据是否合并心衰恶病质状态分为A组(94例)和B组(64例)。B组又根据是否使用左西孟旦分为B1组(41例)和B2组(23例)。比较其基线资料、手术结果和术后恢复情况, 计数资料采用卡方检验比较组间差异, 计量资料采用t检验比较组间差异。结果 A组患者的体重、体重指数(BMI)均高于B组[(67.1±22.1) kg比(58.6±19.1) kg、(26.3±4.4) kg/m2比(23.1±3.5) kg/m2, t=0.251、4.863, P<0.05], 而A组年龄低于B组[(49.2±21.5)岁比(57.3±15.6)岁, t=0.259, P<0.05];A组术前心脏辅助、术前心跳骤停、术后住院时间、ICU滞留时间、呼吸机使用时间、术后心脏辅助、术后恶性心律失常均低于B组[11/94比19/64、6/94比11/64、(16.1±11.9) d比(21.1±13.6) d、(43.2±33.1) h比(59.6±33.9) h、(24.1±22.3) h比(36.9±21.1) h、6/94比14/64、6/94比18/64, χ2=6.880、4.629, t=0.446、2.811、3.619, χ2=8.266、13.972, P<0.05];B1组术前心脏辅助、术前心跳骤停、术后住院时间、ICU滞留时间、术后心脏辅助、术后恶性心律失常均低于B2组[6/41比13/23、2/41比7/23、(19.1±6.6) d比(23.9±4.1) d、(51.1±19.9) h比(69.5±22.1) h、4/41比10/23、5/41比11/23, χ2=10.460、5.989, t=3.157、3.411, χ2=7.931、8.167, P<0.05], 而B1组出院前前白蛋白高于B2组[(189.1±88.3) mg/L比(132.2±79.3) mg/L, t=2.577, P<0.05]。结论恶病质状态与心脏移植患者不良预后相关, 左西孟旦可以部分改善恶病质对心脏移植预后的不良影响。

Objective To observe the effect of levosimendan on the outcome of heart transplantation in patients with heart failure cachexia.Methods A total of 158 patients undergoing heart transplantation during January 2014 and October 2022 were divided into group A(94 cases)and group B(64 cases)according to whether they were complicated with cachexia.Group B was further divided into subgroup B1(41 cases)and subgroup B2(23 cases)according to whether levosimendan was used or not.The baseline data,surgical results and postoperative recovery were compared.The Chi-square test was used for enumeration data and t test was used for measurement data.Results The body weight and body mass index in the group A were higher than those in the group B[(67.1±22.1)kg vs.(58.6±19.1)kg,(26.3±4.4)kg/m2 vs.(23.1±3.5)kg/m2,t=0.251,4.863,P<0.05],and the age in the group A was younger than in the group B[(49.2±21.5)years vs.(57.3±15.6)years,t=0.259,P<0.05].Preoperative heart assistance,preoperative heart arrest,postoperative hospital days,length of ICU stay,ventilation time,postoperative heart assistance,postoperative arrhythmia in the group A were all lower than those in the group B[11/94 vs.19/64,6/94 vs.11/64,(16.1±11.9)days vs.(21.1±13.6)days,(43.2±33.1)h vs.(59.6±33.9)h,(24.1±22.3)h vs.(36.9±21.1)h,6/94 vs.14/64,6/94 vs.18/64,χ2=6.880,4.629,t=0.446,2.811,3.619,χ2=8.266,13.972,P<0.05].Preoperative heart assistance,preoperative heart arrest,postoperative hospital days,the length of ICU stay,postoperative heart assistance,postoperative arrhythmia in the group B1 were all reduced as compared with those in the group B2[6/41 vs.13/23,2/41 vs.7/23,(19.1±6.6)days vs.(23.9±4.1)days,(51.1±19.9)h vs.(69.5±22.1)h,4/41 vs.10/23,5/41 vs.11/23,χ2=10.460,5.989,t=3.157,3.411,χ2=7.931,8.167,P<0.05],and the predischarge prealbumin in the group B1 was higher than that in the group B2[(189.1±88.3)vs.(132.2±79.3)mg/L,t=2.577,P<0.05].Conclusion Heart failure cachexia is related to the poor prognosis of heart transplant patients.Levosimendan can partially improve the adverse effect of cachexia on the prognosis of heart transplantation.