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左西孟旦治疗感染性休克合并心肌抑制的临床观察
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| 篇名： | 左西孟旦治疗感染性休克合并心肌抑制的临床观察 |
| TITLE： | Clinical observation of levosimendan in the treatment of septic shock combined with myocardial depression |
| 摘要： | 目的 探讨左西孟旦对感染性休克合并心肌抑制患者心脏功能、血流动力学和预后的影响，并评价其安全性。方法选择2021年4月－2023年8月入住重庆大学附属三峡医院重症医学科、经充分液体复苏、平均动脉压（MAP）≥65mmHg且接受脉搏指示连续心输出量（PiCCO）监测的感染性休克合并心肌抑制患者，按随机数字表法分为多巴酚丁胺组和左西孟旦组，每组20例。两组患者均静脉泵入重酒石酸去甲肾上腺素注射液0.1～2.0μg/（kg·min）。在此基础上，多巴酚丁胺组患者加用盐酸多巴酚丁胺注射液5～10μg/（kg·min），连续静脉泵入3～7d；左西孟旦组患者加用左西孟旦注射液0.1～0.2μg/（kg·min），连续静脉泵入24h。比较两组患者治疗前及治疗后24、72h的心率（HR）和血流动力学指标[收缩压、舒张压、MAP、中心静脉压（CVP）]、PiCCO监测指标[心功能指数（CFI）、心指数（CI）、每搏量指数（SVI）、血管外肺水指数、全心舒张末期容积指数、肺血管通透性指数（PVPI）、全心射血分数（GEF）、系统血管阻力指数、左心室收缩力指数]和预后指标[用药后3d内死亡情况、机械通气时间、住重症监护病房（ICU）时间、28d病死率]，记录两组患者的不良反应发生情况。结果与同组治疗前比较，多巴酚丁胺组患者治疗后24h的CFI、CI、GEF和治疗后72h的CI、GEF以及左西孟旦组患者治疗后24h的SVI和治疗后72h的SVI、GEF均显著升高，多巴酚丁胺组患者治疗后72h的PVPI显著降低（P＜0.05）；与同期多巴酚丁胺组比较，左西孟旦组患者治疗后24h的HR显著降低，CVP显著升高（P＜0.05）。给药后3d内，两组均无患者死亡；其机械通气时间、住ICU时间、28d病死率和不良反应发生率比较差异均无统计学意义（P＞0.05）。结论对于经充分液体复苏、MAP≥65mmHg且接受PiCCO监测的感染性休克合并心肌抑制患者，左西孟旦在改善心脏功能和血流动力学方面的作用与多巴酚丁胺相当，且不会影响患者预后，也不会增加低血压等不良反应的发生风险。 |
| ABSTRACT： | OBJECTIVE To explore the effects of levosimendan on cardiac function， hemodynamics and prognosis of patients with septic shock complicated with myocardial depression， and evaluate the safety of levosimendan. METHODS Patients with septic shock complicated with myocardial depression who were admitted to the Department of Critical Care Medicine of Chongqing University Three Gorges Hospital from April 2021 to August 2023， underwent adequate fluid resuscitation， had a mean arterial pressure （MAP） ≥65 mmHg， and received pulse indicator continuous cardiac output （PiCCO） monitoring were enrolled. The patients were randomly divided into dobutamine group and levosimendan group according to a random number table， with 20 patients in each group. Both groups received intravenous infusion of Norepinephrine bitartrate injection at a dose of 0.1-2.0 μg/（kg·min）. On this basis， the dobutamine group additionally received intravenous infusion of Dobutamine hydrochloride injection at a dose of 5- 10 μg/（kg·min） for 3 to 7 days， while the levosimendan group additionally received intravenous infusion of Levosimendan injection at a dose of 0.1-0.2 μg/（kg·min） for 24 hours. Heart rate （HR） and hemodynamic parameters [systolic blood pressure， diastolic blood pressure， MAP， central venous pressure （CVP）]， PiCCO monitoring parameters [cardiac function index （CFI）， cardiac index （CI）， stroke volume index （SVI）， extravascular lung water index， global end-diastolic volume index， pulmonary vascular permeability index （PVPI）， global ejection fraction （GEF）， systemic vascular resistance index， left ventricular contractility index]， and prognosis indicators [death within 3 days after administration， mechanical ventilation time，intensive care unit （ICU） stay time， 28-day mortality rate] were compared between the two groups before treatment and at 24 and 72 hours after treatment. Adverse reactions were E-mail：recorded for both groups. RESULTS Compared with before treatment in the same group， CFI， CI and GEF at 24 hours after treatment， CI and GEF at 72 hours after treatment in the dobutamine group， as well as SVI at 24 hours after treatment and SVI and GEF at 72 hours after treatment in the levosimendan group were significantly increased； PVPI at 72 hours after treatment in the dobutamine group was significantly decreased （P＜0.05）. Compared with the dobutamine group during the same period， patients in the levosimendan group had significantly lower HR and significantly higher CVP at 24 hours after treatment （P＜0.05）. Within 3 days after administration， there were no deaths in either group； there were no statistically significant differences in mechanical ventilation time， ICU stay time， 28-day mortality rate， or the incidence of adverse reactions between the two groups （P＞0.05）. CONCLUSIONS For patients with septic shock complicated with myocardial depression who have undergone adequate fluid resuscitation and have a MAP of ≥65 mmHg， levosimendan is comparable to dobutamine in improving cardiac function and hemodynamic parameters， without affecting patients’ prognosis or increasing the risk of adverse reactions such as hypotension. |
| 期刊： | 2024年第35卷第20期 |
| 作者： | 熊芳；刘超；张可祥；周岐龙；卢花；陈建国；岳希；赵建新；潘鹏飞 |
| AUTHORS： | XIONG Fang， LIU Chao，ZHANG Kexiang，ZHOU Qilong，LU Hua，CHEN Jianguo，YUE Xi，ZHAO Jianxin，PAN Pengfei |
| 关键字： | 左西孟旦；感染性休克；心肌抑制；多巴酚丁胺；脉搏指示连续心输出量监测 |
| KEYWORDS： | levosimendan； septic shock； myocardial depression； dobutamine； pulse indicator continuous cardiac output |
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