Fang Mingxing, Dong Shimin
Department of Intensive Care Unit, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China, Corresponding author: Dong Shimin, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Oct;26(10):692-6. doi: 10.3760/cma.j.issn.2095-4352.2014.10.002.
To evaluate the effects of levosimendan on hemodynamics and cardiac function in patients with septic shock.
A prospective single-center randomized controlled trial was conducted. The patients with septic shock admitted to the Department of Critical Care Medicine of the Third Hospital of Hebei Medical University from June 2011 to October 2013 were enrolled. The patients with septic shock received the conventional treatment according to international guidelines for management of severe sepsis and septic shock. Thirty-six patients received the examination of echocardiography and left ventricular ejection fraction (LVEF)≤ 0.45 after fluid resuscitation were enrolled the study, who were divided into two groups according to random number table, with 18 cases in each group. After the conventional treatment, the patients in dobutamine group received intravenous injection of 5 μg × kg⁻¹ min⁻¹ dobutamine for 48 hours immediately after fluid resuscitation, and those in levosimendan group received a 24-hour infusion of 5 μg × kg⁻¹ min⁻¹ dobutamine followed by a 24-hour infusion of 0.2 μg × kg⁻¹ × min⁻¹ levosimendan. The hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output (PiCCO) and ultrasound during treatment.
Compared with dobutamine group, after the treatment in the levosimendan group, stroke volume index (SVI), cardiac index (CI) and left ventricular stroke work index (LVSWI) were significantly increased [SVI (mL/m²): 39.8 ± 5.4 vs. 37.5 ± 4.5, t=-2.762, P=0.020; CI (L × min⁻¹ × m⁻²): 4.6 ± 0.7 vs. 3.6 ± 0.7, t=-9.829, P=0.000; LVSWI (kg ×min⁻ ¹ m⁻²): 33.7 ± 2.4 vs. 28.2 ± 1.2, t=-6.307, P=0.000], and central venous pressure (CVP), intrathoracic blood volume index (ITBVI) and extravascular lung water index (EVLWI) were significantly decreased [CVP (mmHg, 1 mmHg=0.133 kPa): 8.2 ± 0.9 vs. 12.1 ± 0.8, t=3.928, P=0.002; ITBVI (mL/m²): 820 ± 42 vs. 978 ± 69, t=9.472, P=0.000; EVLWI (mL/kg): 6.1 ± 1.6 vs. 8.9 ± 1.7, t=4.467, P=0.001]. Cardiac ultrasound showed that compared with dobutamine group, in the levosimendan group, left ventricular end-systolic volume (LVESI) and end-diastolic volume (LVEDI) were significantly lowered [LVESI (mL/m²): 32.7 ± 9.2 vs. 48.2 ± 13.4, t=0.882, P=0.000; LVEDI (mL/m²): 61.7 ± 11.4 vs. 78.6 ± 13.6, t=2.453, P=0.032], and the LVEF was significantly increased (0.463 ± 0.068 vs. 0.383 ± .085, t=-2.439, P=0.035). Levosimendan also could decrease the lactic acid (mmol/L: 3.4 ± 1.1 vs. 5.2 ± 1.2, t=3.346, P=0.007), and increase the lactate clearance rate (mL/min: 73.2 ± 13.5 vs. 47.6 ± 11.8, t=-4.079, P=0.002), 24-hour urinary output (mL: 2 213.4 ± 354.0 vs. 1 533.8 ± 402.0, t=6.342, P=0.000) and 24-hour cumulative intake (mL: 5 746.6 ± 420.0 vs. 4 156.7 ± 215.0, t=7.126, P=0.000). There were no significant differences in total volume of norepinephrine,mortality in intensive care unit (ICU) and 28-day mortality between two groups.
Levosimendan can increase cardiac ejection function, reduce the heart blood and vascular preload, intrathoracic lung water, improve heart function and systemic hemodynamic indexes of patients with septic shock.
评估左西孟旦对感染性休克患者血流动力学及心功能的影响。
进行一项前瞻性单中心随机对照试验。选取2011年6月至2013年10月在河北医科大学第三医院重症医学科住院的感染性休克患者。感染性休克患者按照国际严重脓毒症及感染性休克治疗指南接受常规治疗。对36例液体复苏后行超声心动图检查且左心室射血分数（LVEF）≤0.45的患者，根据随机数字表分为两组，每组18例。常规治疗后，多巴酚丁胺组患者在液体复苏后立即静脉注射5μg×kg⁻¹ min⁻¹多巴酚丁胺48小时，左西孟旦组患者先静脉输注5μg×kg⁻¹ min⁻¹多巴酚丁胺24小时，随后静脉输注0.2μg×kg⁻¹×min⁻¹左西孟旦24小时。治疗期间采用脉搏指示连续心输出量（PiCCO）和超声评估血流动力学及心功能。
与多巴酚丁胺组相比，左西孟旦组治疗后，每搏量指数（SVI）、心脏指数（CI）和左心室每搏功指数（LVSWI）显著升高[SVI（mL/m²）：39.8±5.4比37.5±4.5，t=-2.762，P=0.020；CI（L×min⁻¹×m⁻²）：4.6±0.7比3.6±0.7，t=-9.829，P=0.000；LVSWI（kg×min⁻¹ m⁻²）：33.7±2.4比28.2±1.2，t=-6.307，P=0.000]，中心静脉压（CVP）、胸腔内血容量指数（ITBVI）和血管外肺水指数（EVLWI）显著降低[CVP（mmHg，1 mmHg = 0.133 kPa）：8.2±0.9比12.1±0.8，t=3.928，P=0.002；ITBVI（mL/m²）：820±42比978±69，t=9.472，P=0.000；EVLWI（mL/kg）：6.1±1.6比8.9±1.7，t=4.467，P=0.001]。心脏超声显示，与多巴酚丁胺组相比，左西孟旦组左心室收缩末期容积（LVESI）和舒张末期容积（LVEDI）显著降低[LVESI（mL/m²）：32.7±9.2比48.2±13.4，t=0.882，P=0.000；LVEDI（mL/m²）：61.7±11.4比78.6±13.6，t=2.453，P=0.032]，且LVEF显著升高（0.463±0.068比0.383±0.085，t=-2.439，P=0.035）。左西孟旦还可降低乳酸（mmol/L：3.4±1.1比5.2±1.2，t=3.346，P=0.007），提高乳酸清除率（mL/min：73.2±13.5比47.6±11.8，t=-4.079，P=0.002）、24小时尿量（mL：2 213.4±354.0比1 533.8±402.0，t=6.342，P=0.000）及24小时累计入量（mL：5 746.6±420.0比4 156.7±215.0，t=7.126，P=0.000）。两组去甲肾上腺素总量、重症监护病房（ICU）死亡率及28天死亡率差异无统计学意义。
左西孟旦可增加感染性休克患者心脏射血功能，降低心脏前后负荷、胸腔内肺水，改善心功能及全身血流动力学指标。
