心脏瓣膜置换术后重度低心排综合征临床治疗分析

Analysis of clinical treatment of severe low cardiac output syndrome after heart valve replacement

目的研究应用米力农联合左西孟旦治疗心脏瓣膜置换术后重度低心排综合征的效果。方法58例心脏瓣膜置换术后重度低心排综合征患者,经单双号随机分为对照组和观察组,每组29例。对照组使用米力农注射液进行治疗,观察组在对照组治疗基础上加用左西孟旦治疗。比较两组患者治疗前后血流动力学指标[心率(HR)、中心静脉压(CVP)、左室射血分数(LVEF)]、血管活性药物(多巴胺、肾上腺素)使用剂量、并发症发生情况。结果治疗后,两组患者HR、CVP均低于治疗前,LVEF均高于治疗前,且观察组患者HR(81.29±3.69)次/min、CVP(7.48±0.92)cm H_(2)O(1 cm H_(2)O=0.098 kPa)均低于对照组的(96.85±5.52)次/min、(11.05±1.16)cm H_(2)O,LVEF(60.84±6.43)%高于对照组的(52.08±4.35)%,差异具有统计学意义(P<0.05)。观察组患者肾上腺素使用剂量(0.03±0.01)μg/(kg·min)、多巴胺使用剂量(5.68±0.36)μg/(kg·min)均低于对照组的(0.19±0.04)、(8.23±0.72)μg/(kg·min),差异具有统计学意义(P<0.05)。观察组并发症发生率6.90%低于对照组的27.59%,差异具有统计学意义(P<0.05)。结论心脏瓣膜置换术后重度低心排综合征患者的临床治疗中,实施米力农和左西孟旦联合治疗方案可获得理想的效果,具有进一步推广应用的价值。

Objective To study the effect of milrinone combined with levosimendan in the treatment of severe low cardiac output syndrome after heart valve replacement.Methods A total of 58 patients with severe low cardiac output syndrome after heart valve replacement were randomly divided into a control group and an observation group,with 29 cases in each group.The control group was treated with milrinone injection,and the observation group was treated with levosimendan on the basis of the control group.Both groups were compared in terms of hemodynamic indexes[heart rate(HR),central venous pressure(CVP),left ventricular ejection fraction(LVEF)]before and after treatment,dosage of vasoactive drugs(dopamine,epinephrine),and incidence of complications.Results After treatment,HR and CVP in both groups were lower than those before treatment in this group,and LVEF was higher than that before treatment in this group;HR of(81.29±3.69)beats/min and CVP of(7.48±0.92)cm H_(2)O(1 cm H_(2)O=0.098 kPa)in the observation group were lower than those of(96.85±5.52)beats/min and(11.05±1.16)cm H_(2)O in the control group;LVEF of(60.84±6.43)%in the observation group was higher than that of(52.08±4.35)%in the control group;the difference were statistically significant(P<0.05).The doses of epinephrine of(0.03±0.01)μg/(kg·min)and doses of dopamine of(5.68±0.36)μg/(kg·min)in the observation group were lower than those of(0.19±0.04)and(8.23±0.72)μg/(kg·min)in the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 6.90%,which was lower than that of 27.59%in the control group,and the difference was statistically significant(P<0.05).Conclusion In the clinical treatment of patients with severe low cardiac output syndrome after cardiac valve replacement,the combination of milrinone and levosimendan has an ideal effect,which has the value of further promotion and application.