左西孟旦在心脏外科重症患者术后早期的应用体会

摘要

Objective To explore the application significance of levosimendan in early stage after the open heart surgery in critical patients. Methods Eighty-eight critical patients who presented with acute cardi-ac dysfunction after cardiac surgery and were treated with levosimendan. The changes in dosage of vasoactive drugs,hemodynamics,proBNP and LVEF were analyzed before and after use of levosimendan. Results The doses of dopamine and norepinephrine at 8 h after use of levosimendan were lower than those before levosimen-dan(P<0.05 ). The dosages of dopamine and norepinephrine at 24 h later were significantly higher compared with those prior to use of levosimendan (P<0.05 ). At 8 h after use of levosimendan,the doses of dobutamine and adrenaline began to decrease and even remain unchanged,significantly differing from the levels before use of levosimendan. The systolic blood pressure(SBP)and heart rate(HR)did not significantly change,whereas central venous pressure(CVP)and lactic acid (Lac)had a declining trend. CVP significantly changed at 24 h after use of levosimendan(P<0.05 ). Lac significantly differed at 24 h following use of levosimendan. Urine volume began to significantly increase at 8 h after use of levosimendan(P<0.05 ). The levels of LVEF were significantly elevated at 24 h,3 d and 1 week after using levosimendan(all P<0.01 ). The level of proBNP gradually declined and significantly differed at 3 d after use of levosimendan (P<0.05 ). Conclusions Ap-plication of evosimendan after open heart surgery can reduce the dosage of vasoactive drugs,maintain the stabil-ity of hemodynamics and effectively improve heart function in critical patients.%目的：探讨左西孟旦在心脏外科重症患者术后早期应用意义。方法88例重症患者心脏术后发生急性心功能不全并应用左西孟旦治疗，总结应用左西孟旦前后患者血管活性药物使用剂量、血流动力学及LVEF、B型脑钠肽前体（proBNP）变化。结果患者应用左西孟旦后多巴胺、去甲肾上腺素使用剂量在应用后8 h开始较用前降低，应用后24 h开始与应用前比较差异有统计学意义（P＜0.05）。多巴酚丁胺、肾上腺素从应用后8 h开始逐渐降低或减停，与应用前比较差异有统计学意义（P＜0.05）；应用前后收缩压、心率无明显变化，中心静脉压（CVP）、乳酸有下降趋势，CVP从应用后24 h、乳酸从应用后8 h开始差异有统计学意义（P＜0.05），尿量从应用后8 h开始显著增多（P＜0.05）。应用后24 h、3 d与7 d LVEF比应用前明显升高（P均＜0.01）；proBNP逐渐下降，从应用后3 d开始与应用前比较差异显著（P＜0.05）。结论心脏外科重症患者术后使用左西孟旦可显著减少血管活性药物的使用，稳定血流动力学，有效改善心功能。