Joshi Reena Khantwal, Aggarwal Neeraj, Aggarwal Mridul, Pandey Rakesh, Dinand Veronique, Joshi Raja
Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India.
Department of Research, Sir Ganga Ram Hospital, New Delhi, India.
Ann Pediatr Cardiol. 2016 Jan-Apr;9(1):9-15. doi: 10.4103/0974-2069.171389.
Levosimendan is a new generation inotrope with calcium sensitizing properties and proven benefits in adults.
This study investigates the use of levosimendan as a first line inotrope in congenital heart surgery.
Prospective, observational study in a tertiary care center.
One hundred and ten patients undergoing congenital cardiac surgery received levosimendan at a loading dose of 12 mcg/kg during rewarming on cardiopulmonary bypass followed by continuous infusion of 0.1 mcg/kg/min for 48 h. Hemodynamic parameters were recorded at the time of admission to Intensive Care Unit, and at 3 h, 6 h, 12 h, 24 h, and 48 h thereafter.
Categorical variables were compared using Chi-square test. Non-normally distributed quantitative variables were compared between groups using Kruskal-Wallis test.
At discharge from operating room (OR), 36 (32.7%) patients required levosimendan alone to maintain optimum cardiac output, 59 (53.6%) patients required the addition of low-dose adrenaline (<0.1 mcg/kg/min) and 15 (13.6%) patients required either increment in adrenaline to high-dose (≥0.1 mcg/kg/min) or starting another inotrope/vasoactive agent. Overall, there were five mortalities. Hypotension leading to discontinuation of levosimendan was not found in any patient. Arrhythmias were observed in three patients. Fifty-four patients were extubated in the OR.
Levosimendan-based inotropic regime offers optimized cardiac output with a well-controlled heart rate and a low incidence of arrhythmias in patients undergoing all categories of congenital heart surgeries.
左西孟旦是一种具有钙增敏特性的新一代强心剂，已证实对成人有益。
本研究探讨左西孟旦在先天性心脏病手术中作为一线强心剂的应用。
在一家三级护理中心进行的前瞻性观察性研究。
110例接受先天性心脏手术的患者在体外循环复温期间接受负荷剂量为12微克/千克的左西孟旦，随后以0.1微克/千克/分钟的速度持续输注48小时。在重症监护病房入院时以及此后3小时、6小时、12小时、24小时和48小时记录血流动力学参数。
分类变量采用卡方检验进行比较。非正态分布的定量变量采用Kruskal-Wallis检验在组间进行比较。
在手术室（OR）出院时，36例（32.7%）患者仅需左西孟旦即可维持最佳心输出量，59例（53.6%）患者需要加用低剂量肾上腺素（<0.1微克/千克/分钟），15例（13.6%）患者需要将肾上腺素增加至高剂量（≥0.1微克/千克/分钟）或开始使用另一种强心剂/血管活性药物。总体而言，有5例死亡。未发现任何患者因低血压导致停用左西孟旦。3例患者观察到心律失常。54例患者在手术室拔管。
基于左西孟旦的强心方案可为各类先天性心脏手术患者提供优化的心输出量，心率控制良好，心律失常发生率低。
