左西孟旦对急性心肌梗死合并心源性休克患者心功能和血流动力学影响分析

Effect of levosimendan on cardiac function and hemodynamics in patients with acute myocardial infarction and cardiogenic shock

目的研究左西孟旦对急性心肌梗死合并心源性休克患者心功能和血流动力学的影响。方法选取于三六三医院治疗的118例急性心肌梗死合并心源性休克患者,按随机数字表法分为对照组和观察组,每组59例。对照组进行常规治疗,观察组在常规治疗的基础上加以左西孟旦治疗。比较2组患者治疗前和治疗3 d后的心功能指标[心搏量(SV)、心脏指数(CI)、左心室射血分数(LVEF)、纵向收缩期峰值应变率(SRs)]、心肌功能指标[肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK‑MB)]、血管加压素(AVP)、血管紧张素Ⅱ(AngⅡ)血流动力学参数[中心静脉压(CVP)、肺毛细血管楔压(PCWP)、平均动脉压(MAP)、左室舒张末期容积(LVEDV)等]。比较2组患者休克持续时间、药物剂量、住重症监护室(ICU)时间、主动脉内球囊反搏(IABP)使用时间及恶性心律失常发生率等。结果治疗前2组患者各项指标比较差异无统计学意义(P>0.05);治疗3 d后,观察组SV、LEVF、CI、SRs及MAP均高于对照组(P<0.05),AVP、AngⅡ、cTnI、CK‑MB、CVP、PCWP及LVEDV均低于对照组(P<0.05);观察组休克持续时间、药物用量、住ICU时间、IABP使用时间均少于对照组(P<0.05);观察组恶性心律失常发生率为13.56%,低于对照组(28.81%),差异有统计学意义(P<0.05)。结论左西孟旦能改善急性心肌梗死合并心源性休克患者的血流动力学,具有临床应用价值。

Objective To study the effect of levosimendan on cardiac function and hemodynamics in patients with acute myocardial infarction and cardiogenic shock.Methods Totally 118 patients with acute myocardial infarction complicated with cardiogenic shock admitted to 363 Hospital were randomly assigned to control group or observation group,with 59 cases in each group.All the patients in both groups received routine treatment,and the observation group was given levosimendan additionally.The cardiac function indexes such as stroke volume(SV),cardiac index(CI),left ventricular ejection fraction(LVEF),and longitudinal peak systolic strain rate(SRs),the myocardial funtion indexes such as troponin I(cTnI),creatine kinase isoenzyme(CK‑MB),vasopressin(AVP)and angiotensin(AngⅡ),hemodynamic parameters such as central venous pressure(CVP),pulmonary capillary wedge pressure(PCWP),mean arterial pressure(MAP),and left ventricular end‑diastolic volume(LVEDV)were compared between the two groups before treatment and on day 3 after treatment.Shock duration,drug dose,time staying in intensive care unit(ICU),use of intra‑aortic balloon counterpulsation(IABP),and incidence of malignant arrhythmia were also compared.Results There were no significant differences in all indexes between the two groups before treatment(P>0.05).On day 3 after treatment,SV,LEVF,CI,SRs,and MAP in the observation group were significantly higher than those in the control group(P<0.05),while AVP,AngⅡ,cTnI,CK‑MB,CVP,PCWP,and LVEDV in the observation group were significantly lower than those in the control group(P<0.05).The duration of shock,the dosage of drugs,ICU time,and IABP time in the observation group were significantly lower than those in the control group(P<0.05).The incidence of malignant arrhythmia in the observation group was significantly lower than that in the control group(13.56%vs 28.81%,P<0.05).Conclusion Levosimendan can improve the hemodynamics of patients with acute myocardial infarction and cardiogenic shock.It has clinical application value.