【摘要】 目的探讨左西孟旦在心内直视术重症患者术后不同时间使用的临床疗效。方法 2012年11月至2014年8月共有92例术后使用左西孟旦的心内直视术重症患者根据纳入标准纳入研究,根据使用时间的不同分为2组:(1)A组:返回ICU后即刻开始使用组,共42例;(2)B组:术后使用血管活性药物剂量及种类不断增多后开始使用组,共50例,记录并比较2组术后血管活性药物的使用情况;pro BNP、LVEF的变化;呼吸机辅助时间、ICU停留时间、术后住院时间;后续使用心脏机械辅助装置情况、并发症发生及死亡情况。结果 A组术后使用血管活性药物用量低于B组,使用时间短于B组(P<0.05);A组和B组使用左西孟旦后LVEF较使用前均有明显升高,pro BNP均有明显下降,A组使用前的LVEF低于B组(P<0.05),但A组使用后24 h、用后3 d、用后7 d的LVEF明显高于B组(P<0.05);B组使用前pro BNP高于A组(P<0.05),使用后2组各时间点pro BNP均呈下降趋势,数值上B组均高于A组,但差异无统计学意义(P>0.05);A组机械通气时间、ICU停留时间及术后住院时间均短于B组(P<0.05);B组术后并发症发生率高于A组(P<0.05),B组后续使用心脏机械辅助装置(IABP、ECMO)及死亡率高于A组,但差异无统计学意义(P>0.05)。结论在心内直视术重症患者术后即开始使用左西孟旦能降低血管活性药物的使用剂量、减少使用时间,更快改善心功能,减少低心排综合征及急性肾损伤的发生,减少住院时间,并有降低死亡率及后续心脏机械辅助装置使用的可能。更多还原

【Abstract】 Objective To investigate the therapeutic effect of levosimendan in different time points on severe patients after open heart surgery. Methods Ninety-two severe patients who were treated with levosimendan after open heart surgery from November 2012 to August 2014 were enrolled in the study. According to the application time of levosimendan,the patients were divided into two group,group A( n = 42) : levosimendan was applied immediately after the patients came back intensive care unit( ICU),group B( n = 50) : levosimendan was administrated after the kinds and dose of vasoactive drugs were increased. After open heart surgery,the application condition of vasoactive drugs,changes of pro BNP,LVEF,mechanical ventilation time,ICU monitoring time and hospitalizing time,the condition of using mechanical heart assist device,patients’ complications and mortality were observed and compared between the two groups. Results The application dose of vasoactive drugs after operation in group A was significantly lower than that in group B,and application time was shorter than that in group B. After application of levosimendan,LVEF was obviously increased,as compared with that before application for both groups,however,pro BNP was obviously decreased. Before application of levosimendan,LVEF in group A was significantly lower than that in group B( P < 0. 05),however,at 24 h,3d,7d after application of levosimendan,LVEF in group A was significantly higher than that in group B. Before application of levosimendan,pro BNP in group B was higher than that in group A,after application of levosimendan,pro BNP in different time points was decreased in both groups,but there was no significant difference( P > 0. 05). The mechanical ventilation time,ICU monitoring time and hospitalizing time in group A were significantly shorter than those in group B,however,the incidence of complications after operation in group B was significantly higher than that in group A( P < 0. 05). The incidences of using mechanical heart assist device( IABP,ECMO) and mortality in group B were higher than those in group A,however,there were no significant differences between two groups( P > 0. 05).Conclusion The application of levosimendan immediately after open heart surgery can reduce the usage dose of vasoactive drugs and usage time,improve cardiac function more quickly,decrease the incidence of low cardiac output syndrome and acute renal failure,reduce hospitalizing time,moreover,reduce possibly the mortality and usage of subsequent mechanical heart assist device.更多还原