摘要
目的观察左西孟旦对急性心肌梗死(AMI)合并心源性休克(CS)患者经皮冠状动脉介入治疗(PCI)术后的疗效及预后。方法选取2019年5月至2021年5月于解放军总医院第七医学中心心脏重症监护病房68例AMI-CS PCI术后患者,按照治疗方案的不同分为观察组和对照组,每组各34例。对照组在常规治疗基础上以2.5~10.0μg/(kg·min)速度泵入多巴酚丁胺,观察组在对照组基础上加用左西孟旦以0.1~0.2μg/(kg·min)速度泵入,比较两组治疗前及治疗24 h、72 h后心功能指标[N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)]及血流动力学指标如心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)、每搏输出量(SV)、左心室舒张末期容积(LVEDV)、组织灌注氧代谢变化如氧分压(PaO_(2))、氧合指数(OI)、中心静脉血氧饱和度(ScvO_(2))、乳酸(Lac)、乳酸清除率等,记录并比较两组患者住院期间不良反应发生率和28 d生存率。结果治疗前两组患者一般临床资料比较无明显差异。与治疗前相比,治疗24 h、72 h后两组患者LVEF、SV、MAP、CI、PaO_(2)、OI、ScvO_(2)、乳酸清除率等均较治疗前升高,NT-proBNP、CVP、HR、LVEDV、Lac等均较治疗前下降(P<0.05),且观察组LVEF、SV、MAP、CI、PaO_(2)、OI、ScvO_(2)、乳酸清除率均高于对照组(P<0.05),NT-proBNP、CVP、HR、LVEDV、Lac均低于对照组(P<0.05)。治疗期间两组不良反应发生率比较无明显差异(P>0.05)。随访28 d,Kaplan-Meire生存曲线显示,两组生存率未见显著差异(P>0.05)。结论左西孟旦可稳定AMI-CS PCI术后患者的血流动力学,改善左室功能和组织灌注,且安全性较好,但患者生存率未见明显提高。
Objective To observe the curative effect of levosimendan and prognosis in patients with acute myocardial infarction complicated by cardiogenic shock(AMI-CS)after percutaneous coronary intervention(PCI).Methods AMI-CS after PCI(n=68)were chosen from Heart Intensive Care Unit in the Seventh Medical Center of Chinese PLA General Hospital from May 2019 to May 2021,and divided,according to therapeutic plans,into observation group and control group(each n=34).The control group received dobutamine pump[2.5~10.0μg/(kg·min)]on the base of routine general treatment,and observation group additionally received levosimendan pump[0.1~0.2μg/(kg·min)].The indexes of heart function including N-terminal pro-brain natriuretic peptide(NTproBNP)and left ventricular ejection fraction(LVEF),indexes of hemodynamics including heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),stroke volume(SV)and left ventricular end-diastolic volume(LVEDV),and changes of oxygen metabolism in tissue perfusion including pressure of oxygen(PaO_(2)),oxygenation index(OI),central venous oxygen saturation(ScvO_(2)),lactic acid(Lac)and Lac clearance rate were compared between 2 groups before and 24 h and 72 h after treatment.The incidence rates of adverse reactions during hospitalization and 28-d survival rate were recorded and compared in 2 groups.Results The general clinical materials had no significant difference between 2 groups before treatment.Compared with before treatment,LVEF,SV,MAP,CI,PaO_(2),OI,ScvO_(2)and Lac clearance rate increased,and NT-proBNP,CVP,HR,LVEDV and Lac decreased after treatment for 24 h and 72 h(P<0.05).LVEF,SV,MAP,CI,PaO_(2),OI,ScvO_(2)and Lac clearance rate were higher(P<0.05),and NT-proBNP,CVP,HR,LVEDV and Lac were lower in observation group than those in control group(P<0.05).The incidence rates of adverse reactions had no significant difference between 2 groups during treatment(P>0.05).The results of Kaplan-Meire survival curve analysis showed that the survival rate had no significant difference between 2 groups after followed up for 28 d(P>0.05).Conclusion Levosimendan can stabilize hemodynamics,improve left ventricular function and tissue perfusion in AMI-CS patients after PCI with higher safety,but the survival rate has not been significantly improved.
作者
张笑笑
赵冰
翟晋慧
许爱斌
崔振双
石宇杰
李俊峡
张源波
刘宇
Zhang Xiaoxiao;Zhao Bing;Zhai Jinhui;Xu Aibin;Cui Zhenshuang;Shi Yujie;Li Junxia;Zhang Yuanbo;Liu Yu(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;不详)
出处
《中国循证心血管医学杂志》
2023年第3期311-315,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
中华国际医学交流基金会心血管多学科整合思维研究基金(Z-2016-23-1823)。
作者简介
共同通讯作者:张源波,E-mail:178113175@qq.com;共同通讯作者:刘宇,E-mail:davidliuyu@sina.com。
