左西孟旦、米力农和多巴酚丁胺治疗体外循环心脏瓣膜置换术后低心排血量综合征的比较
Comparison of Levosimendan, Milrinone and Dobutamine in treating Low Cardiac Output Syndrome Following Valve Replacement Surgeries with Cardiopulmonary Bypass.
作者信息
Yunus Mohd, Karim Habib Md Reazaul, Saikia Manuj Kumar, Bhattacharyya Prithwis, Dey Samarjit
机构信息
Resident, Department of Anaesthesiology, Critical Care and Pain Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences , Shillong, Meghalaya, India .
Sub Dean Research and Additional Professor, Department of Anaesthesiology, Critical Care and Pain Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences , Shillong, Meghalaya, India .
出版信息
J Clin Diagn Res. 2016 Dec;10(12):UC05-UC08. doi: 10.7860/JCDR/2016/23584.8987. Epub 2016 Dec 1.
INTRODUCTION
Low Cardiac Output Syndrome (LCOS) following Cardiopulmonary Bypass (CPB) is common and associated with increased mortality. Maintenance of adequate cardiac output is one of the primary objectives in management of such patients.
AIM
To compare Levosimendan, Milrinone and Dobutamine for the treatment of LCOS after CPB in patients who underwent valve replacement surgeries.
MATERIALS AND METHODS
Sixty eligible patients meeting LCOS were allocated into three treatment groups: Group A-Levosimendan (loading dose 10μg/kg over 10 minutes, followed by 0.1μg/kg/min); Group B-Milrinone (loading dose 50 mcg/kg over 10 minutes followed by 0.5mcg/kg/min) and Group C-Dobutamine @ 5μg/kg/min to achieve target cardiac index (CI) of > 2.5 L/min/m. In case of failure, other drugs were added as required. Hemodynamic parameters were monitored using EV1000TM clinical platform till 30 minutes post CPB. INSTAT software was used for statistics and p<0.05 was considered significant.
RESULTS
The mean±standard deviation of time taken by Dobutamine, Levosimendan and Milrinone to bring the CI to target were 11.1±8.79, 11.3±6.34 and 16.62±9.33 minutes respectively (p=0.064). Levosimendan was equally effective in increasing and maintaining adequate CI as compared to Dobutamine (p>0.05). Levosimendan and Milrinone increased MAP (Mean Arterial Pressure) equally while Dobutamine was more effective as compared to both Levosimendan and Milrinone 20 minute onwards (p<0.01). Milrinone was less effective in increasing the stroke volume as compared to Dobutamine and Levosimendan while Dobutamine and Levosimendan were equally effective. There was no difference in the HR (Heart Rate) achieved with all these three drugs.
CONCLUSION
Levosimendan is equally effective to Dobutamine and better than Milrinone for the treatment of LCOS following CPB in patients undergoing valve replacement surgeries.
引言
体外循环（CPB）后低心排血量综合征（LCOS）很常见，且与死亡率增加相关。维持足够的心排血量是此类患者管理的主要目标之一。
目的
比较左西孟旦、米力农和多巴酚丁胺对接受瓣膜置换手术患者CPB后LCOS的治疗效果。
材料与方法
60例符合LCOS标准的合格患者被分为三个治疗组：A组——左西孟旦（10分钟内静脉注射负荷剂量10μg/kg，随后以0.1μg/kg/min持续静脉输注）；B组——米力农（10分钟内静脉注射负荷剂量50μg/kg，随后以0.5μg/kg/min持续静脉输注）；C组——多巴酚丁胺5μg/kg/min静脉输注，目标是使心脏指数（CI）>2.5L/min/m²。若效果不佳，则根据需要加用其他药物。使用EV1000TM临床平台监测CPB后30分钟内的血流动力学参数。采用INSTAT软件进行统计学分析，p<0.05被认为具有统计学意义。
结果
多巴酚丁胺、左西孟旦和米力农使CI达到目标值的平均时间±标准差分别为11.1±8.79、11.3±6.34和16.62±9.33分钟（p=0.064）。与多巴酚丁胺相比，左西孟旦在增加和维持足够CI方面同样有效（p>0.05）。左西孟旦和米力农在增加平均动脉压（MAP）方面效果相当，而多巴酚丁胺在20分钟后比左西孟旦和米力农更有效（p<0.01）。与多巴酚丁胺和左西孟旦相比，米力农在增加每搏输出量方面效果较差，而多巴酚丁胺和左西孟旦效果相当。这三种药物在达到的心率（HR）方面没有差异。
结论
对于接受瓣膜置换手术的患者CPB后LCOS的治疗，左西孟旦与多巴酚丁胺效果相当，且优于米力农。
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