左西孟旦对脓毒症休克患者心肌损伤的保护作用探讨

目的:探讨左西孟旦对脓毒症休克患者心肌损伤的保护作用。方法:选择我院2013年1月至2017年12月收治的149例脓毒症休克患者,根据随机数字表法分为观察组(73例)及对照组(76例),对照组给予常规治疗及静脉注射多巴酚丁胺48 h,观察组在常规治疗基础上给予静脉注射多巴酚丁胺24h后再静脉注射左西孟旦24 h。观察和比较两组的心脏功能参数、血流动力学指数、肌钙蛋白、乳酸、去甲肾上腺素、机械通气例数及ICU病死率。结果:治疗前,两组的左室射血分数、左室舒张期末容积指数及左室收缩期末容积指数对比差异无统计学意义(P0.05);治疗后,观察组的心排血量、每搏量指数、左室每搏作功指数均明显高于对照组,中心静脉压低于对照组(P0.05)。对比治疗前,治疗后观察组的心脏功能参数有明显改善(P0.05),而对照组无明显差别(P0.05)。此外,两组治疗后肌钙蛋白及乳酸水平均低于治疗前,且观察组明显低于对照组(P0.05)。两组的去甲肾上腺素总用量、机械通气例数及ICU病死率对比差异均无统计学意义(P0.05)。结论:左西孟旦对脓毒症休克患者具有心肌保护作用,可以改善患者心脏功能,优化血流动力学,但并不能降低患者ICU病死率。

Protective Effect of Leosimendan on the Myocardial Injury in Patients with Septic Shock

ABSTRACT Objective: To investigate protective effect of leosimendan on the myocardial injury in patients with septic shock. Methods: 149 cases with septic shock from Jan. 2013 to Dec. 2017 in our hospital were chosen, who were divided into the observation group (73 cases) and control group (76 cases), the control group were given routine treatment and intravenous administration of dobu- tamine for 48 h, the observation group were given routine treatment, intravenous injection of dobutamine for 24 h and intravenous injec- tion of leosimendan for 24 h. The cardiac function parameters, hemodynamic index, troponin, lactate, norepinephrine, mechanical venti- lation and ICU mortality of two groups were compared. Results: Before treatment, the left ventricular ejection fraction, left ventricular di- astolic final volume index and left ventricular systolic final volume index of two groups had no significant different(P>0.05). After treat- ment, the cardiac function parameters were got improved in the observation group(P<0.05), while there was no defference in the control group(P>0.05). The cardiac output, each stroke index, left ventricle per beat index in observation group were all higher than control group, while the central venous pressure were lower than control group(P<0.05). The troponin and lactate levels after treatment were all lower than before treatment, while the observation group was obvious lower than control group(P<0.05), the total amount of nore- pinephrine, mechanical ventilation and ICU mortality between groups had no significant difference(P>0.05). Conclusion: Leosimendan had myocardial protective effect on patients with septic shock, which could improve the heart function, optimize hemodynamics, while have could not decrease the ICU mortality.