左西孟旦在左心室功能低下患者不停跳冠状动脉旁路移植术中的应用

中国临床药理学与治疗学 ›› 2013, Vol. 18 ›› Issue (10): 1160-1163.

左西孟旦在左心室功能低下患者不停跳冠状动脉旁路移植术中的应用

牛兆倬¹, 孙立新², 林明山¹, 孙龙¹, 生伟¹, 侯文明¹, 池一凡¹

¹青岛市市立医院心脏外科,
²青岛市市立医院麻醉科,青岛 266071,山东

收稿日期:2013-03-11 修回日期:2013-06-23 出版日期:2013-10-26 发布日期:2013-09-30
作者简介:牛兆倬,男,硕士研究生,研究方向:成人心脏外科学。Tel: 15165212155 E-mail: zz_niu@hotmail.com

Clinical effects of levosimendan in patients with left ventricular systolic dysfunction under off-pump coronary artery bypass grafting

NIU Zhao-zhuo¹, SUN Li-xin², LIN Ming-shan¹, SUN Long¹, SHENG Wei¹, HOU Wen-ming¹, CHI Yi-fan¹

¹Department of Cardiovascular Surgery,
²Department of anaesthesia, Qingdao Municipal Hospital, Qingdao 266071,Shandong,China

Received:2013-03-11 Revised:2013-06-23 Online:2013-10-26 Published:2013-09-30

摘要/Abstract

摘要： 目的:探讨左西孟旦对左心室收缩功能低下患者在不停跳冠状动脉旁路移植术(CABG)中心肌保护效果。方法:本院心外科在2010 年5月至2012年11月,抽取术前左室射血分数小于45％的CABG病例40例,随机分为试验组和对照组各20 例,对照组在手术中开始应用多巴胺静脉维持泵入,试验组同期加用左西孟旦,初始负荷量为 10 μg/kg, 注射时间 10 min, 随即以 0.1～0.2 μg·kg^-1·min^-1 起泵入持续 23 h。记录两组患者治疗后监护室滞留时间、房颤发生率、多巴胺治疗时间、30 d 死亡率、记录手术后前 3 d 的床边心脏超声测量左心室射血分数(LVEF)值比较,以及手术后早期ICU即刻(0)、术后6、24、48 h 的肌钙蛋白I(cTnI)指标变化。结果:试验组和对照组均无死亡病例。与对照组比较,试验组患者手术后多巴胺治疗时间缩短(P<0.05),房颤发生率降低(P<0.05)。术后 6 h 和 24 h 试验组的cTnI指标低于对照组(P<0.05)。试验组第1、2天LVEF指标高于对照组 (P<0.05)。其余无统计学差异(P>0.05)。结论:左西孟旦对于术前左心室收缩功能低下的CABG患者具有一定心肌保护作用。

关键词: 左西孟旦, 心脏手术, 冠脉旁路移植术, 左心室射血分数, 收缩功能低下

Abstract: AIM: To investigate the clinical effect of levosimendan in patients with lower left ventricular eject fraction(LVEF) under off-pump coronary artery bypass grafting(CABG).METHODS: From May 2010 to November 2012, 40 cases with lower LVEF below 45% undergoing elective CABG were randomly devided into treatment group (20 cases) and control group (20 cases). All the cases received dopamine treatment perioperatively, and levosimendan were additionally used in the treatment group. The ICU time, the incidence of atrial fibrillation(AF),the duration of dopamine use, the mortality in the first 30 days were recorded. The level of LVEF in the first 3 days and the cTnI at 0,6,24,48 h after the operation were examined. RESULTS: No case died in both groups. Comparing with control group, treatment group had lower incidence of AF (P<0.05), and shorter time of dopamine use (P<0.05). Treatment group had a higher LVEF in the first two days than those in control group(P<0.05). Treatment group had lower cTnI at the 6h and 24h time point after the operation than those in control group(P<0.05). There was no remarkable difference between two groups in other aspects .CONCLUSION: Levosimendan has cardiac protection effect on patients under CABG with lower LVEF.

Key words: Levosimendan, Cardiac surgery, Coronary artery bypass grafting, Left ventricular ejection fraction, Systolic dysfunction

中图分类号:

R614

牛兆倬, 孙立新, 林明山, 孙龙, 生伟, 侯文明, 池一凡. 左西孟旦在左心室功能低下患者不停跳冠状动脉旁路移植术中的应用[J]. 中国临床药理学与治疗学, 2013, 18(10): 1160-1163.

NIU Zhao-zhuo, SUN Li-xin, LIN Ming-shan, SUN Long, SHENG Wei, HOU Wen-ming, CHI Yi-fan. Clinical effects of levosimendan in patients with left ventricular systolic dysfunction under off-pump coronary artery bypass grafting[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(10): 1160-1163.

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