Meyer K, Schipke J D, Klocke R C, Gams E, Korbmacher B
Research Group Experimental Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.
Thorac Cardiovasc Surg. 2008 Oct;56(7):379-85. doi: 10.1055/s-2008-1038729. Epub 2008 Sep 22.
Levosimendan improves ventricular function, induces vasodilation and induces myocardial preconditioning. We determined the external efficiency and assessed the effects on arrhythmias.
In isolated, blood-perfused rabbit hearts, levosimendan (0.75 micromol) or placebo was administered, while hemodynamics were recorded. After no-flow ischemia and reperfusion, data were recorded again.
Placebo in normoxic hearts did not affect measurements, while levosimendan increased heart rate (+ 18 %) and improved coronary output (+ 52 %), stroke volume (+ 28 %), maximal left ventricular pressure (+ 30 %), maximal rate of pressure increase (+ 36 %), work (+ 68 %), minimal rate of pressure increase (+ 53 %), coronary blood flow (+ 41 %), coronary resistance (- 19 %) and external efficiency (33 %; P < 0.05). During reperfusion, hemodynamics in the levosimendan group were significantly better preserved compared with the placebo group. Early reperfusion arrhythmias were decreased (levosimendan group: 7 +/- 3 % vs. placebo group: 25 +/- 17 %; P < 0.05).
Levosimendan does not impair diastole, dilates coronary vessels, induces pharmacological preconditioning, improves external efficiency and exerts antiarrhythmic properties during reperfusion. As this drug protects the heart from reperfusion injury, it seems well suited for treating dysfunctional hearts after cardiac surgery.
左西孟旦可改善心室功能、诱导血管舒张并诱导心肌预处理。我们测定了其外在效能并评估了对心律失常的影响。
在离体、血液灌注的兔心脏中，给予左西孟旦（0.75微摩尔）或安慰剂，同时记录血流动力学参数。在无血流缺血和再灌注后，再次记录数据。
在常氧心脏中，安慰剂对测量指标无影响，而左西孟旦可使心率增加（+18%），并改善冠脉输出量（+52%）、每搏输出量（+28%）、左心室最大压力（+30%）、最大压力上升速率（+36%）、作功（+68%）、最小压力上升速率（+53%）、冠脉血流量（+41%）、冠脉阻力（-19%）和外在效能（33%；P<0.05）。在再灌注期间，与安慰剂组相比，左西孟旦组的血流动力学参数得到了更好的保留。早期再灌注心律失常减少（左西孟旦组：7±3% vs. 安慰剂组：25±17%；P<0.05）。
左西孟旦不损害舒张功能，扩张冠脉血管，诱导药理学预处理，提高外在效能，并在再灌注期间发挥抗心律失常作用。由于该药物可保护心脏免受再灌注损伤，似乎非常适合用于治疗心脏手术后功能失调的心脏。
