左西孟旦联合主动脉球囊反搏可有效改善急性心肌梗死合并心源性休克患者的预后

Levosimendan combined with aortic balloon counterpulsation could effectively improve the prognosis of patients with acute myocardial infarction complicated with cardiogenic shock

目的:本研究评估左西孟旦联合主动脉球囊反搏(IABP)对急性心肌梗死(AMI)合并心源性休克(CS)患者的疗效及安全性。方法:连续收集AMI合并CS植入IABP行急性经皮冠状动脉介入治疗(PCI)患者82例,随机分为观察组(左西孟旦+IABP)和对照组(单纯IABP),使用化学发光法检测2组血清N末端-脑钠肽前体(NT-proBNP)、肌钙蛋白I(cTnI)水平,使用酶联免疫吸附检测超敏C反应蛋白(HsCRP)的水平。统计患者IABP辅助时间、CCU入住天数及总住院天数;心肌梗死后30 d心脏主要不良事件发生情况:再发心肌梗死、脑卒中、再次血运重建、死亡及再次住院率。结果:治疗5 d后,与对照组比较,观察组患者NT-proBNP下降更加明显[(-3895.37±1589.59) pg/mL vs(-2568.53±1864.23)pg/mL,P=0.0026],hsCRP降低更加显著[(-42.56±20.35)mg/L vs(-25.63±12.69)mg/L,P=0.0032],肌钙蛋白峰值更低[(89.65±36.58)ng/mL vs(98.56±32.69)mg/L,P=0.042];观察组IABP持续时间更短[(4.5±2.5)d vs(6.5±3.5)d,P=0.032],CCU入住时间更短[(7.5±3.5)d vs(9.5±4.5)d,P=0.039],总住院时间明显降低[(10.5±5.5)d vs(13.5±6.5)d,P=0.025]。2组患者住院期间死亡率比较,差异无统计学意义(P=0.696)。观察组30 d内心血管主要不良事件发生率低于对照组(19.05%vs 25.00%,P=0.515),急诊就医次数更少[(1.2±0.8)vs(2.2±1.8),P=0.042],再次住院次数更少[(0.8±1.2)vs(1.5±1.6),P=0.049]。出院时,观察组标准EQ-5D-3L健康调查问卷评分低于对照组(P=0.038),随访30 d时继续保持降低(P=0.029)。结论:左西孟旦联合IABP对AMI合并CS患者疗效肯定且安全可靠。

Objective:To evaluate the efficacy of levosimendan combined with intra-aortic balloon counterpulsation(IABP) in patients with acute myocardial infarction(AMI) complicated with cardiogenic shock(CS) and safety.Methods:A total of 82 patients with AMI combined with CS implantation with IABP who underwent acute percutaneous coronary intervention(PCI) were collected and randomly divided into an observation group(traditional medicine + levosimendan) and a control group(traditional medicine).NT-proBNP,HsCRP and cTn1 levels were detected.The IABP assistance time,CCU stay days and overall hospitalization days,the incidence of major adverse cardiac events 30 days after myocardial infarction(recurrent myocardial infarction,stroke,revascularization,death and rehospitalization rate) were observed.Results:After 5 days of treatment,as compared with the control group,the NT-proBNP(-3895.37±1589.59 vs.-2568.53±1864.23 pg/mL,P=0.0026),the HsCRP(-42.56±20.35 vs.-25.63±12.69 mg/L,P=0.0032) and peak troponin(89.65±36.58 vs.98.56±32.69 mg/L,P=0.042) significantly decreased in the observation group.The observation group had shorter duration of IABP(4.5±2.5 vs.6.5±3.5 days,P=0.032),shorter CCU stay time(7.5±3.5 vs.9.5±4.5 days,P=0.039) and total hospital stay time(10.5±5.5 days vs.13.5±6.5 days,P=0.025) than in the control group.There was no significant difference in mortality during hospitalization between the two groups(P=0.696).The main adverse cardiovascular events in the observation group within 30 days showed a decreasing trend as compared with the control group(19.05% vs.25.00%,P=0.515).Within 30 days,the observation group had fewer emergency hospital visits(1.2±0.8 vs.2.2±1.8,P=0.042) and fewer readmissions(0.8±1.2 vs.1.5±1.6,P=0.049) than the control group.Standard EQ-5D-3L health questionnaire score in the observation group significantly decreased at discharge(P=0.038) and 30 days(P=0.029) as compared with the control group.Conclusion:Levosimendan combined with IABP is effective,safe and reliable in patients with AMI and CS.