摘要
目的观察左西孟旦治疗急性心肌梗死(AMI)合并心原性休克(CS)患者的临床疗效及其对脉搏指示连续心排量(PICCO)监测血流动力学参数的影响。方法选择2017年6月至2019年12月浙江省嘉兴市第二医院收治的AMI合并CS患者106例,按随机数字表法分为对照组和观察组,每组53例。对照组接受常规综合干预,观察组在对照组基础上接受左西孟旦治疗,首先12μg/kg负荷剂量在10 min内静脉注射,之后按0.1μg/(kg·min)静脉泵入,持续1 h后按0.2μg/(kg·min)静脉泵入,持续24 h;对照组予以5%葡萄糖注射液,静脉滴注速度、时间与观察组相同。两组均在治疗24 h后采用PICCO监测治疗前后血流动力学参数,包括心率(HR)、中心静脉压(CVP)、心脏指数(CI)、全心舒张末期容积指数(GEDVI)以及血管外肺水指数(EVLWI),并观察神经体液指标,包括去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ),心功能指标包括心搏量(SV)、左室射血分数(LVEF),比较两组疗效及并发症发生情况。结果治疗24 h后,两组患者的HR、CVP、GEDVI以及EVLWI均下降,且观察组患者治疗后上述指标低于对照组[(90.26±12.61)次/min比(97.82±12.58)次/min、(9.85±1.14)cmH2O(1 cmH2O=0.098 kPa)比(11.63±1.37)cmH2O、(759.53±62.47)ml/m^(2)比(867.21±63.24)ml/m^(2)、(7.95±1.56)ml/kg比(9.01±1.78)ml/kg],观察组患者治疗后CI高于对照组[(3.58±0.74)L/(min·m^(2))比(2.37±0.86)L/(min·m^(2))],差异均有统计学意义(P<0.05)。治疗24 h后,两组患者NE、AngⅡ水平均下降,且观察组上述指标低于对照组[(284.64±52.85)ng/L比(312.57±48.92)ng/L、(92.34±16.31)ng/L比(105.67±18.53)ng/L],差异有统计学意义(P<0.05)。治疗24 h后,两组患者的SV、LVEF均上升,且观察组患者上述指标明显高于对照组[(60.42±5.93)ml比(54.42±6.14)ml、(41.62±4.19)%比(36.87±4.36)%],差异有统计学意义(P<0.05)。治疗后观察组患者主动脉内球囊反博(IABP)使用时间少于对照组[(61.52±15.41)h比(89.56±17.63)h],观察组肾功能损伤率低于对照组[3.77%(2/53)比18.87%(10/53)],差异均有统计学意义(P<0.05);两组30 d病死率、心脏破裂率比较差异无统计学意义(P>0.05)。结论左西孟旦能够显著改善AMI合并CS患者的PICCO监测血流动力学指标、神经体液指标、心功能指标,对患者的肾脏具有保护作用,但不能明显改善患者的30 d病死率。
Objective To observe the clinical efficacy of levosimendan in the treatment of patients with acute myocardial infarction(AMI)combined with cardiogenic shock(CS)and its effects on monitoring hemodynamic parameters of pulse index continuous cardiac output(PICCO).Methods One hundred and six patients with AMI combined with CS admitted and treated in Jiaxing Second Hospital from June 2017 to December 2019 were divided into the control group and observation group according to the random number table method,with 53 cases in each group.The control group received routine comprehensive intervention,while the observation group received levosimendan treatment based on the control group.In observation group,12μg/kg of levosimendan was administered intravenously within 10 min,then,0.1μg/(kg·min)was administered intravenously and continued for 24 h.In control group,5%glucose injection was administered intravenously,and the intravenous infusion rate and time was same as that in observation group.Both groups were treated for 24 h.PICCO was used to monitor the hemodynamic parameters,including heart rate(HR),central venous pressure(CVP),cardiac index(CI),global end-diastolic volume index(GEDVI)and extravascular lung water index(EVLWI)before and after the treatment;the neurohumoral indexes including norepinephrine(NE),angiotensinⅡ(AngⅡ);cardiac function indexes including stroke volume(SV),left ventricular ejection fraction(LVEF),and the efficacy and complications were observed and compared between two groups.Results After 24 h of treatment,the levels of HR,CVP,GEDVI,EVLWI in two groups were decreased,and the levels of above index in the observation group were lower than those in the control group:(90.26±12.61)beats/min vs.(97.82±12.58)beats/min,(9.85±1.14)cmH2O(1 cmH2O=0.098 kPa)vs.(11.63±1.37)cmH2O,(759.53±62.47)ml/m^(2) vs.(867.21±63.24)ml/m^(2),(7.95±1.56)ml/kg vs.(9.01±1.78)ml/kg;after treatment the level of CI in the observation group was higher than that in the control group:(3.58±0.74)L/(min·m^(2))vs.(2.37±0.86)L/(min·m^(2)),and the differences were statistically significant(P<0.05).After 24 h of treatment,the levels of NE and AngⅡin two groups was decreased,and the levels of NE and AngⅡin the observation were lower than those in the control group:(60.42±5.93)ml vs.(54.42±6.14)ml,(41.62±4.19)%vs.(36.87±4.36)%,and the differences were statistically significant(P<0.05).After 24 h of treatment,the time of intra-aortic balloon counterpulsation(IABP)in the observation was shorter than that in the control group:(61.52±15.41)h vs.(89.56±17.63)h;the injury rate of renal functions in the observation was lower than that in the control group:3.77%(2/53)vs.18.87%(10/53),and the differences were statistically significant(P<0.05).There was no significant difference in mortality and other complications after 30 d of follow-up between two groups(P>0.05).Conclusions Levosimengdan can significantly improve the PICCO hemodynamics,neurohumoral indexes and cardiac function indexes of patients with AMI and CS.It has a protective effect on the kidneys of patients,but it cannot significantly improve the 30-day mortality rate of patients.
作者
白鹭
张健铖
何涛
陆磊
Bai Lu;Zhang Jiancheng;He Tao;Lu Lei(Department of Emergency,Jiaxing Second Hospital,Zhejiang Jiaxing 314000,China;Department of Traditional Chinese Medicine,Lianshui People′s Hospital Affiliated to Kangda College of Nanjing Medical University,Jiangsu Lianshui 223400,China)
出处
《中国医师进修杂志》
2021年第10期935-939,共5页
Chinese Journal of Postgraduates of Medicine
关键词
心肌梗塞
休克
心原性
血流动力学
左西孟旦
Myocardial infarction
Shock,cardiogenic
Hemodynamics
Levosimendan
