左西孟旦和肾上腺素对心脏术后低心排综合征治疗作用的比较

Levosimendan vs epinephrine in treatment of low cardiac output after cardiac surgery

摘要:

目的 比较左西孟旦和肾上腺素对心脏术后低心排综合征（LCOS）的作用。方法 将48例心脏术后LCOS患者随机分为两组，左西孟旦组（A组，n＝23）按0.05～0.2μg/（kg·min）持续24h，肾上腺素组（B组，n＝25）按0.01～0.04μg/（kg·min）持续1周，维持平均动脉压≥65mmHg。监测心率、平均动脉压、肺毛细血管楔压、中心静脉压、心输出量、心指数、全身血管阻力；用心脏超声分别评价用药前和用药后3和7d的心功能；监测用药前和用药后24和48h的血乳酸值、血肌酐、尿素氮、尿量。观察术后并发症及预后情况。结果 两种药物均能显著增加心输出量和心指数（P＜0.05）。A组用药后各时间点全身血管阻力均较B组明显下降（P＜0.05），且均较用药前明显下降（P＜0.05）。A组用药后24，48h平均动脉压与用药前相比均有显著下降（P＜0.05）。心脏超声结果显示两种药均能改善心功能（P＜0.05）。用药后血乳酸值均显著降低（P＜0.05）。A组用药后48h，尿素氮、血肌酐及尿量均较用药前变化显著（P＜0.05），且该时间点尿素氮较B组显著降低（P＜0.05）。与B组相比，A组房颤发生率显著减少（P＜0.05），术后并发症也有减少的趋势。结论 两种药物均能明显提高心脏术后LCOS患者血流动力学及心功能指标，改善组织灌注，而左西孟旦对患者肾功能更有益。

Abstract:

Objective To compare the effects of levosimendan vs epinephrine on low cardiac output syndrome (LCOS) after cardiac surgery. Methods Forty-eight patients with LCOS after cardiac surgery in our department from 2011 to 2012 were enrolled in this prospective study. They were randomly assigned to levosimendan group [n＝23, 0.05 to 0.2μg·(kg·min) for 24h] and epinephrine group [n＝25, 0.01 to 0.04μg·(kg·min) for 1 week] to maintain the mean arterial pressure ≥65mmHg. Their heart rate, mean arterial pressure, pulmonary artery wedge pressure, central venous pressure, cardiac output, cardiac index, systemic vascular resistance and cardiac function (evaluated by echocardiography before and on 3 and 7d after drug injection, respectively) were monitored as well as blood lactate and kidney function (urea nitrogen, serum creatinine and urine output before and at 24 and 48h after drug injection, respectively). The postoperative complications and prognosis were also observed. Results Cardiac output and cardiac index were significantly increased, but blood lactate was obviously decreased after the drug injection compared with before the injection (P＜0.05). Levosimendan injection for 48h resulted in significant changes in urea nitrogen, serum creatinine and urine output (P＜0.05), with the first one significantly lower than that of epinephrine group (P＜0.05). There was significantly lower incidence of atrial fibrillation in levosimendan group than in epinephrine group (P＜0.05). Levosimendan injection also caused a decreasing trend of post-operative complications. Conclusion Both leosimendan and adrenaline obviously improve the hemodynamic indices and cardiac functions, and tissue perfusion in LCOS patients after cardiac surgery. Leosimendan is more beneficial to renal function.