Lomivorotov Vladimir V, Cherniavskiy Alexander M, Boboshko Vladimir A, Kornilov Igor A, Lomivorotov Vladimir N, Karaskov Alexander M
Academician E N Meshalkin Research Institute of Circulation Pathology, Novosibirsk, Russia.
Asian Cardiovasc Thorac Ann. 2011 Apr;19(2):154-9. doi: 10.1177/0218492311401143.
The purpose of our study was to compare the efficiency of levosimendan and preventive intra-aortic balloon pump in high-risk cardiac patients (left ventricular ejection fraction <35%) operated under cardiopulmonary bypass. In 20 patients, intra-aortic balloon pump was started 16-18 h before surgery; another 20 had a levosimendan infusion starting after induction of anesthesia with an initial bolus of 12 μg·kg(-1) for 10 min, followed by 0.1 μg·kg(-1)·min(-1) for 24 h. Postoperative complications, hemodynamics, and markers of cardiac damage were analyzed. In the levosimendan group, cardiac index was significantly higher 5 min after cardiopulmonary bypass, at the end of the operation, 2 and 4 h after perfusion, compared to the intra-aortic balloon pump group. The level of troponin I in the levosimendan group was significantly lower at 6 h after the operation. Intensive care unit stay was significantly shorter in the levosimendan group. It was concluded that the use of levosimendan in high-risk cardiac patients is as effective as intra-aortic balloon pump, in terms of maintaining stable hemodynamic during and after operations under cardiopulmonary bypass. The lower level of troponin I at 6 h postoperatively suggests cardioprotective properties of levosimendan, but requires further investigation.
我们研究的目的是比较左西孟旦和预防性主动脉内球囊反搏在接受体外循环手术的高危心脏患者（左心室射血分数<35%）中的有效性。20例患者在手术前16 - 18小时开始使用主动脉内球囊反搏；另外20例在麻醉诱导后开始输注左西孟旦，初始推注剂量为12μg·kg⁻¹，持续10分钟，随后以0.1μg·kg⁻¹·min⁻¹的速度输注24小时。分析术后并发症、血流动力学和心脏损伤标志物。与主动脉内球囊反搏组相比，左西孟旦组在体外循环后5分钟、手术结束时、灌注后2小时和4小时的心脏指数显著更高。左西孟旦组术后6小时肌钙蛋白I水平显著更低。左西孟旦组的重症监护病房停留时间显著更短。得出的结论是，在高危心脏患者中，就体外循环手术期间和术后维持稳定的血流动力学而言，使用左西孟旦与主动脉内球囊反搏同样有效。术后6小时较低的肌钙蛋白I水平提示左西孟旦具有心脏保护作用，但需要进一步研究。
