左西孟旦在心力衰竭患者非心脏外科围手术期的应用研究

Application of levosimendan during perioperative period of noncardiac surgery in patients with heart failure

关键词:  左西孟旦  心力衰竭  外科围手术期  NT-ProBNP  左室射血分数

Key words:  levosimendan  heart failure  perioperative period of surgery  NT-ProBNP  left ventricular ejection fraction

摘要:

目的 探讨心力衰竭患者外科围手术期应用左西孟旦对预后的影响。方法 收集石家庄市第一医院2016年1月至2017年8月外科收治的需手术治疗的左室射血分数在40%~50%之间的心力衰竭患者116例，随机分为治疗组56例和对照组60例，对照组应用利尿剂、强心苷等传统治疗心衰的药物，治疗组在传统药物治疗基础上加用左西孟旦，术前测定NT-ProBNP水平，并行心脏彩超检查测定左室射血分数（LVEF），术前48 h内使用左西孟旦静脉泵入，观察术后有无急性左心功能衰竭，并于术后5~7天复查NT-ProBNP水平及心脏彩超测定左室射血分数。监测两组患者心肌酶变化情况。随访6个月，比较两组患者心血管事件再住院率。结果 术后急性左心衰竭发生率为治疗组3.5%（2例）和对照组13.3%（8例），差异有统计学意义（P<0.05）。治疗组及对照组术后2 h CK分别为（298.7±36.4和411.6±48.3），CKMB分别为（41.7±9.7和76.3±15.6），cTNI分别为（35.3±7.2和62.5±9.4），治疗组心肌酶水平明显低于对照组，差异具有统计学意义（P<0.05）。术后复查NT-ProBNP分别为（825±227和2217±574），差异有统计学意义（P<0.05）。治疗组术前与术后左室射血分数分别为（45.3±3.8和49.6±5.3），差异有统计学意义（P<0.05）。治疗组及对照组术后左心室射血分数分别为（49.6±5.3和44.2±3.6），差异有统计学意义（P<0.05）。两组患者随访6个月，累计心血管事件再住院率分别为10.7%与23.3%，差异有统计学意义（P<0.05）。结论 需要进行外科手术的心力衰竭患者术前应用左西孟旦可改善心功能，减少急性心力衰竭的发生，提高围手术期的安全性，改善患者临床预后。

Abstract:

Objective To investigate the effect of levosimendan on prognosis during perioperative period in patients with heart failure. Methods The 116 patients, who were admitted in our hospital from 2016.01 to 2017.08 with heart failure and left ventricular ejection fractions(LVEF) between 40% and 50%, were randomly divided into two groups:treatment group (n=56) and control group(n=60). The control group was treated with diuretics, cardiac glycosides and other traditional drugs for heart failure, while the treatment group was treated with levosimendan on the basis of traditional drugs. The treatment group was administered with levosimendan at 48 hour before surgery. NT-ProBNP and LVEF were measured before and 5-7 days after surgery in all patients. The rate of cardiovascular rehospitalization in the two groups were observed during six months of follow up. Results The rates of acute left heart failure were 3.5% (2 cases) in the treatment group and 13.3% (8 cases) in the control group, respectively; the difference was statistically significant (P<0.05). After 24 hours of surgery, CK, CKMB and cTnI were (298.7±36.4 vs. 411.6±48.3), (41.7±9.7 vs. 76.3±15.6) and (35.3±7.2 vs. 62.5±9.4) in the treatment group and the control group, respectively. The level of myocardial enzymes in the treatment group were significantly lower than those in the control group (P<0.05). The postoperative NT-ProBNP were 825±227 and 2217±574 in the treatment group and the control group respectively, and there was statistical difference between the two groups (P<0.05). The left ventricular ejection fraction before and after surgery in the treatment group were 45.3±3.8 and 49.6±5.3, and there was statistical difference between the two groups (P<0.05). The left ventricular ejection fraction of the treatment group and the control group were 49.6±5.3 and 44.2±3.6 respectively, and there was statistical difference between the two groups (P<0.05). The patients in the two groups were followed up for 6 months. The rehospitalization rate was 10.7% in the treatment group and 23.3% in the control group. The difference between the two groups was statistically significant (P<0.05). Conclusions Levosimendan on patients with heart failure can improve cardiac function, reduce the incidence of acute left ventricular failure, improve perioperative safety and clinical outcomes.