摘要
目的探讨采用左西孟旦对合并左心功能不全患者行心脏手术预后的影响。方法选取2016年6月至2018年12月于本院心外科就诊的72例需行常温下非体外循环冠状动脉旁路移植术(OPCABG)且合并左心功能不全的冠心病患者作为研究对象,采用随机数字表法分为治疗组和对照组,每组36例。对照组给予常规改善循环、维持水电解质酸碱平衡等对症支持治疗,治疗组在对照组基础上于术前24 h及术后加用左西孟旦。比较两组术后不同时间点血流动力学指标[血管外肺水指数(ELWI)、全身血管阻力指数(SVRI)、平均动脉压(MAP)水平]、心功能指标[心率(HR)、心指数(CI)、全心射血分数(GEF)、左心室射血分数(LVEF)]、预后情况、并发症发生情况。结果两组EIWI、MAP、SIRI时间比较差异有统计学意义(P<0.05);两组SIRI比较差异有统计学意义(P<0.05);两组EIMI、MAP、SIRI交互比较差异无统计学意义;两组EIMI、MAP比较差异无统计学意义。术后6 h,两组ELWI、MAP水平均高于术后12 h、24 h、3 d,差异有统计学意义(P<0.05);术后6 h,两组SVRI均低于术后12 h、24 h、3 d,且术后3 d,治疗组低于对照组,差异有统计学意义(P<0.05)。两组HR、CI、GEF、LVEF组间、交互比较差异有统计学意义(P<0.05)。两组HR、CI时间比较差异有统计学意义(P<0.05);两组GEF、LVEF时间比较差异无统计学意义。术后6 h,两组HR低于术后12 h、24 h、3 d,且术后3 d,治疗组高于对照组,差异有统计学意义(P<0.05);术后6 h,两组CI均低于术后12 h、24 h、3 d,且术后3 d,治疗组高于对照组,差异有统计学意义(P<0.05);术后3 d,治疗组GEF高于对照组,差异有统计学意义(P<0.05);术后6 h,两组LVEF低于术后12 h、24 h、3 d,差异有统计学意义(P<0.05);术后6 h、3 d,治疗组LVEF高于对照组,差异有统计学意义(P<0.05)。两组总住院时间比较差异无统计学意义;治疗组术后机械通气时间、ICU住院时间均短于对照组,IABP置入率低于对照组(P<0.05)。术后,两组均无死亡、再发心肌梗死等并发症;治疗组心律失常、肾功能损害及肝、肾功能损害发生率均低于对照组(P<0.05)。结论初步提示左西孟旦可能改善合并左心功能不全的患者心脏手术后血流动力学、心功能指标及预后,值得临床推广应用。
Objective To investigate the effect of levosimendan on the prognosis of cardiac surgery in patients with left heart dysfunction.Methods Atotal of 72 patients with coronary heart disease who required non-cardiopulmonary bypass grafting(OPCABG)and left ventricular insufficiency at room temperature from June 2016 to December 2018 were selected as the study subjects,and they were divided into treatment group and control group by random number table method,with 36 cases in each group.The control group was given routine symptomatic supportive therapy such as improving circulation and maintaining the acid-base balance of water,electrolyte,and electrolyte,and the treatment group was given levosimendan 24 h before and after surgery on the basis of conventional treatment in the control group.The hemodynamic indexes(extravascular pulmonary fluid index[ELWI],systemic vascular resistance index[SVRI],mean arterial pressure[MAP]level),cardiac function indexes(heart rate[HR],cardiac index[CI],total cardiac ejection fraction[GEF],left ventricular ejection fraction[LVEF]),prognosis,and complications of the two groups at different time points after surgery were compared.Results There were significant differences of EIWI,MAP,SIRI between the two groups of time(P<0.05);there were significant differences of SIRI between the two groups(P<0.05);and there were no significant differences of EIMI,MAP,SIRI between the two groups of interaction;there were no significant differences of EIMI,MAP between the two groups.At 6 h after surgery,the ELWI and MAP levels of the two groups were higher than those at 12 h,24 h and 3 d after surgery,with significant differences(P<0.05),and 6 h after surgery,the SVRI levels of the two groups were lower than those in 12 h,24 h and 3 d after surgery,and the treatment group was lower than that in the control group at 3 d after surgery,and the difference was statistically significant(P<0.05).There were significant differences of HR、CI、GEF、LVEF between the two groups of inter-group and interaction(P<0.05);there were significant differences of HR、CI between the two groups of time(P<0.05);and there were no significant differences of GEF、LVEF between the two groups of time.At 6 h after surgery,the HR of the two groups was lower than that of 12 h,24 h and 3 d after surgery,and 3 d after surgery,the treatment group was higher than that of the control group,and the difference was statistically significant(P<0.05);6 h after surgery,the CI of the two groups was lower than that of 12 h,24 h and 3 d after surgery,and 3 d after surgery,the treatment group was higher than that of the control group,the difference was statistically significant(P<0.05);3 d after surgery,the GEF of the treatment group was higher than that of the control group(P<0.05);6 h after surgery,the LVEF of the two groups was lower than that of 12 h after surgery.At 24 h and 3 d,the difference was statistically significant(P<0.05),and 6 h and 3 d after surgery,the LVEF of treatment group was higher than the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the total length of hospital stay between the two groups.The postoperative mechanical ventilation time and ICU hospital stay in the treatment group were shorter than those in the control group,and the IABP insertion rate was lower than that in the control group(P<0.05);after surgery,there were no complications such as death or recurrent myocardial infarction in either group.The incidence rates of arrhythmia,renal function damage,liver and kidney function damage in the treatment group were lower than those in the control group(P<0.05).Conclusion Leosimendan may improve the hemodynamic and cardiac function indexes after cardiac surgery in patients with left heart dysfunction,and improve the prognosis,which is worthy of clinical promotion and application.
作者
陈晓明
冯文都
曾妮
许妹萍
CHEN Xiaoming;FENGWendu;ZENG Ni;XU Meiping(The Second Affiliated Hospital of Fujian Medical University,Quanzhou,Fujian,362000,China)
出处
《当代医学》
2022年第28期73-77,共5页
Contemporary Medicine
关键词
左西孟旦
左心功能不全
心脏外科
Leosimendan
Left ventricular insufficiency
Cardiac surgery
