Tasouli Androniki, Papadopoulos Kirillos, Antoniou Theophanie, Kriaras Ioannis, Stavridis Georges, Degiannis Dimitrios, Geroulanos Stephanos
ICU, Onassis Cardiac Surgery Center, Marathonamahon 18, 14572 Athens, Greece.
Eur J Cardiothorac Surg. 2007 Oct;32(4):629-33. doi: 10.1016/j.ejcts.2007.07.010. Epub 2007 Aug 15.
Levosimendan is a promising new inotrope. We investigate the proper time for its infusion during or after open-heart surgery to avoid complications related with low-output syndrome and high dosage of inotropes.
Forty-five consecutive patients were randomised to receive levosimendan in addition to the conventional therapy, its infusion starting in the operating theatre (Group OT) or in the ICU (Group ICU) when low-output syndrome was certified and were consequently dependent on classical inotropic support and IABP. Levosimendan was infused at a rate of 0.1 microg/kg min without loading dose, the infusion being for at least 24h to a maximum 48 h.
Levosimendan was well tolerated, with the simultaneous infusion of norepinephrine if required. Its efficacy was identical in both groups with improvement in the haemodynamic and functional status of patients (amelioration of stroke volume, cardiac index and mixed venous blood oxygen saturation, increase of left ventricular ejection fraction by echo study, de-escalation of traditional inotropes, subtraction of IABP and reduction in BNP plasma levels). The ICU stay and hospital stay were significantly decreased in patients of Group OT, compared to patients of Group ICU. Four patients died because of multiple organs dysfunction syndrome (MODS) due to sepsis (all patients of Group ICU).
Levosimendan is a safe and efficient choice in the management of low-output syndrome during and after open-heart surgery. The shortening of hospitalisation and the trend for better outcome confirm its clear superiority when the infusion starts from the operating theatre.
左西孟旦是一种很有前景的新型正性肌力药物。我们研究其在心脏直视手术期间或术后输注的合适时机,以避免与低心排血量综合征及高剂量正性肌力药物相关的并发症。
45例连续患者被随机分组,除接受常规治疗外,在确认出现低心排血量综合征且因此依赖传统正性肌力支持和主动脉内球囊反搏(IABP)时,一组在手术室开始输注左西孟旦(手术室组),另一组在重症监护病房(ICU)开始输注(ICU组)。左西孟旦以0.1微克/千克·分钟的速率输注,无负荷剂量,输注至少24小时,最长48小时。
左西孟旦耐受性良好,必要时可同时输注去甲肾上腺素。两组疗效相同,患者的血流动力学和功能状态均有改善(每搏量、心脏指数和混合静脉血氧饱和度改善,超声心动图显示左心室射血分数增加,传统正性肌力药物减量,IABP撤除,血浆脑钠肽水平降低)。与ICU组患者相比,手术室组患者的ICU住院时间和住院时间显著缩短。4例患者因败血症导致多器官功能障碍综合征(MODS)死亡(均为ICU组患者)。
左西孟旦是心脏直视手术期间及术后低心排血量综合征管理中的一种安全有效的选择。住院时间缩短以及更好的预后趋势证实了从手术室开始输注时其明显的优越性。