Russ Martin A, Prondzinsky Roland, Carter Justin M, Schlitt Axel, Ebelt Henning, Schmidt Hendrik, Lemm Henning, Heinroth Konstantin, Soeffker Gerold, Winkler Matthias, Werdan Karl, Buerke Michael
Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany.
Crit Care Med. 2009 Dec;37(12):3017-23. doi: 10.1097/CCM.0b013e3181b0314a.
Levosimendan improves left ventricular hemodynamic function in patients with cardiogenic shock. However, its impact on right ventricular performance has not been determined. We compared the hemodynamic effects of levosimendan on left and right ventricular function in patients with intractable cardiogenic shock following myocardial infarction.
Observational hemodynamic study.
Tertiary care center university hospital.
Fifty-six patients with cardiogenic shock secondary to myocardial infarction were treated with percutaneous revascularization (including intra-aortic balloon pump when appropriate) and commenced on conventional inotropic therapy.
Twenty-five consecutive patients with cardiogenic shock due to myocardial infarction who had not improved sufficiently with conventional therapy (including dobutamine and norepinephrine) received levosimendan (as a bolus of 12 microg/kg per minute for 10 mins then 0.1 microg/kg per minute--0.2 mug/kg per minute) as "bail-out" therapy for 24 hrs while invasive hemodynamic parameters were recorded.
Levosimendan therapy was associated with a significant increase in cardiac index from 2.1 +/- 0.1 to 3.0 +/- 0.2 L x min x m (p < .01). In addition, levosimendan enhanced right ventricular cardiac power index (0.14 +/- 0.19 to 0.18W +/- 0.12, p < .001), while pulmonary vascular resistance fell from 227.7 +/- 94.5 to 178.1 +/- 62.3 dyne x s x cm (p = .002). No significant change in central venous pressure or mean pulmonary artery pressure was observed. The observed hemodynamic improvement was sustained after the levosimendan infusion was stopped.
Levosimendan infusion for cardiogenic shock following acute myocardial infarction improved hemodynamic parameters of right ventricular performance. Furthermore, we describe the use of right ventricular cardiac power index as a hemodynamic parameter of right ventricular performance.
左西孟旦可改善心源性休克患者的左心室血流动力学功能。然而，其对右心室功能的影响尚未确定。我们比较了左西孟旦对心肌梗死后顽固性心源性休克患者左、右心室功能的血流动力学效应。
观察性血流动力学研究。
三级医疗中心大学医院。
56例心肌梗死后心源性休克患者接受了经皮血管重建术（必要时包括主动脉内球囊反搏），并开始接受常规的正性肌力治疗。
25例因心肌梗死导致心源性休克且常规治疗（包括多巴酚丁胺和去甲肾上腺素）效果不佳的连续患者接受左西孟旦（先以每分钟12μg/kg的剂量推注10分钟，然后以每分钟0.1μg/kg至每分钟0.2μg/kg的剂量）作为“挽救”治疗24小时，同时记录有创血流动力学参数。
左西孟旦治疗使心脏指数从2.1±0.1显著增加至3.0±0.2L·min·m（p<0.01）。此外，左西孟旦提高了右心室心脏功率指数（从0.14±0.19增至0.18W±0.12，p<0.001），而肺血管阻力从227.7±94.5降至178.1±62.3达因·秒·厘米（p=0.002）。中心静脉压或平均肺动脉压未观察到显著变化。停止输注左西孟旦后，观察到的血流动力学改善仍持续存在。
急性心肌梗死后心源性休克患者输注左西孟旦可改善右心室功能的血流动力学参数。此外，我们描述了使用右心室心脏功率指数作为右心室功能的血流动力学参数。
