左西孟旦对急性心肌梗死合并心源性休克及高体循环血管阻力患者的血流动力学影响
Hemodynamic effects of levosimendan in acute myocardial infarction complicated by cardiogenic shock and high systemic vascular resistance.
作者信息
Tsagalou Eleftheria P, Kanakakis John, Anastasiou-Nana Maria I, Drakos Stavros G, Ntalianis Argirios S, Malliaras Konstantinos, Lazaris Nikolaos, Katsaros Fotis, Nanas John N
机构信息
Department of Clinical Therapeutics University of Athens, School of Medicine, Athens, Greece.
出版信息
Acute Card Care. 2009;11(2):99-106. doi: 10.1080/17482940902807286.
BACKGROUND
Levosimendan (LEVO), a new inodilator, improves hemodynamic function in patients with decompensated heart failure and preserved arterial blood pressure. Data on its use in patients with cardiogenic shock (CS) are scarce. The present study was undertaken to evaluate the hemodynamic effects of supplemental therapy with levosimendan (LEVO) in acute myocardial infarction (MI) and refractory cardiogenic shock (CS).
METHODS
In 25 patients presenting in CS after acute MI, LEVO was administered for 24 h in doses ranging between 0.05 and 0.20 microg/kg/min, as tolerated, preceded by 6-microg/kg over 10 min, in addition to catecholamines. Hemodynamic measurements were made before and 24 h after initiation of the LEVO infusion.
RESULTS
Hemodynamic improvement was limited to 13 patients with systemic vascular resistances (SVR) > or =18 W. LEVO increased the cardiac index from 1.5+/-0.3 l/min/m2 to 2.1+/-0.4 l/min/m2 (P = 0.002) and cardiac power from 0.462+/-0.164 W to 0.645+/-0.179 W (P = 0.022), and decreased SVR from 23+/-5 to 21+/-6.7 Wood units (P = 0.001) and pulmonary capillary wedge pressure from 24+/-9 mmHg to 16+/-11 mmHg (P = 0.059). No hemodynamic improvement was observed during LEVO administration in 12 patients with SVR < 18 W.
CONCLUSION
The hemodynamic benefit conferred by LEVO added to catecholamines in patients with CS after acute MI was limited to patients with high SVR.
背景
左西孟旦（LEVO）是一种新型的血管扩张剂，可改善失代偿性心力衰竭患者的血流动力学功能，并维持动脉血压。关于其在心源性休克（CS）患者中的应用数据较少。本研究旨在评估左西孟旦（LEVO）补充治疗对急性心肌梗死（MI）合并顽固性心源性休克（CS）患者的血流动力学影响。
方法
25例急性心肌梗死后出现心源性休克的患者，在使用儿茶酚胺类药物的基础上，先静脉注射负荷剂量6 μg/kg，持续10分钟，然后根据耐受情况以0.05至0.20 μg/kg/min的剂量静脉输注左西孟旦（LEVO）24小时。在开始输注左西孟旦（LEVO）前及输注24小时后进行血流动力学测量。
结果
血流动力学改善仅限于13例全身血管阻力（SVR）≥18 W的患者。左西孟旦（LEVO）使心脏指数从1.5±0.3 l/min/m²增加至2.1±0.4 l/min/m²（P = 0.002），心脏功率从0.462±0.164 W增加至0.645±0.179 W（P = 0.022），全身血管阻力从23±5降至21±6.7伍德单位（P = 0.001），肺毛细血管楔压从24±9 mmHg降至16±11 mmHg（P = 0.059）。12例全身血管阻力（SVR）<18 W的患者在输注左西孟旦（LEVO）期间未观察到血流动力学改善。
结论
急性心肌梗死后心源性休克患者在儿茶酚胺类药物基础上加用左西孟旦（LEVO）的血流动力学益处仅限于全身血管阻力高的患者。
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