Jacky Annina, Rudiger Alain, Krüger Bernard, Wilhelm Markus J, Paal Sebastian, Seifert Burkhardt, Spahn Donat R, Bettex Dominique
Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
J Cardiothorac Vasc Anesth. 2018 Oct;32(5):2112-2119. doi: 10.1053/j.jvca.2018.04.019. Epub 2018 Apr 6.
Pharmacodynamics suggests that levosimendan might be a valuable inotrope for weaning from extracorporeal life support (ECLS). As there is a paucity of evidence regarding the effectiveness and safety of such an approach, the aim was to report the authors' experiences in ECLS weaning before and after the implementation of levosimendan in clinical practice.
Retrospective before-and-after study.
Cardiac intensive care unit of a university hospital.
A total of 64 patients under ECLS for postcardiotomy cardiac failure, who underwent an ECLS weaning trial.
Group comparisons between patients treated with levosimendan and patients treated with milrinone were made with the Mann-Whitney U test or the Pearson chi-squared test. Results are given as median (interquartile range) or numbers (percentages).
Of 64 patients, 26 (41%) received levosimendan. Successful ECLS weaning was achieved in 24 (92%) and 30 patients (79%) in the levosimendan and milrinone group, respectively (p = 0.18). In the levosimendan group, fewer patients had an intra-aortic balloon pump for weaning (2 [7.7%] v 15 [40%], p = 0.008). The support with norepinephrine was similar in the levosimendan and milrinone groups at the time of ECLS removal (0.06 [0.01-0.11] v 0.07 [0.01-0.16] µg/kg/min, p = 0.64) and 24 hours later (0.06 [0.04-0.09] v 0.04 [0.00-0.09] µg/kg/min, p = 0.15). Twenty-eight days (9/26 (35%) v 14/35 (40%), p = 0.28) and 180 days (13/26 [50%] v 15/34 [44%], p = 0.80) mortalities after ECLS removal were similar in the levosimendan and the milrinone groups.
Levosimendan enabled ECLS weaning without increasing norepinephrine requirements when compared to a control group receiving milrinone.
药效学表明，左西孟旦可能是一种用于脱离体外生命支持（ECLS）的有价值的正性肌力药物。由于缺乏关于这种方法有效性和安全性的证据，本研究旨在报告作者在临床实践中应用左西孟旦前后进行ECLS撤机的经验。
回顾性前后对照研究。
一所大学医院的心脏重症监护病房。
共有64例因心脏术后心力衰竭接受ECLS治疗并进行ECLS撤机试验的患者。
采用Mann-Whitney U检验或Pearson卡方检验对接受左西孟旦治疗的患者和接受米力农治疗的患者进行组间比较。结果以中位数（四分位间距）或例数（百分比）表示。
64例患者中，26例（41%）接受了左西孟旦治疗。左西孟旦组和米力农组分别有24例（92%）和30例（79%）成功实现ECLS撤机（p = 0.18）。在左西孟旦组，较少患者在撤机时使用主动脉内球囊反搏（2例[7.7%]对15例[40%]，p = 0.008）。在撤除ECLS时及24小时后，左西孟旦组和米力农组去甲肾上腺素的使用支持情况相似（撤除ECLS时：0.06[0.01 - 0.11]对0.07[0.01 - 0.16]μg/kg/min，p = 0.64；24小时后：0.06[0.04 - 0.09]对0.04[0.00 - 0.09]μg/kg/min，p = 0.15）。左西孟旦组和米力农组在撤除ECLS后28天（9/26[35%]对14/35[40%]，p = 0.28）和180天（13/26[50%]对15/34[44%]，p = 0.80）的死亡率相似。
与接受米力农的对照组相比，左西孟旦能够实现ECLS撤机且不增加去甲肾上腺素的需求量。
