Department of Cardiac Anesthesiology, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India.
Department of Cardiac Surgery, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India.
Ann Card Anaesth. 2021 Apr-Jun;24(2):217-223. doi: 10.4103/aca.ACA_160_19.
Prophylactic milrinone is commonly used to prevent Low Cardiac Output Syndrome (LCOS) after pediatric cardiac surgery. This study compares the use of levosimendan with milrinone when used as the primary inotrope following pediatric cardiac surgery.
Forty infants undergoing corrective surgery for congenital heart disease were recruited during the study and randomized into two groups (group L and group M). During rewarming, a loading dose of levosimendan or milrinone was administered followed by a 24-hour infusion of the chosen inotrope. Echocardiographic variables were measured postoperatively. Statistical analysis was done with SPSS-20 computer package. Association between the variables was found by independent t test. P < 0.05 was considered statistically significant.
Mean age and weight of the patient in Group L was 8.55 ± 5.83 months and 6.05 ± 2.09 kgs, while that in group M was 6.85 ± 3.57 months and 5.26 ± 2.11 kgs. 4 patients (20%) treated with levosimendan had LCOS in comparison with 6 (30%) patients in those treated with milrinone. Echocardiographic parameters in both groups L and M were comparable (cardiac index 3.47 ± 0.76 vs 3.72 ± 1.05 L/min/m, EF 66.10 ± 7.82% vs 59.34 ± 10.74%, stroke volume index 25.4 ± 6.3 vs 27.74 ± 10.35 mL/m). The duration of ventilation, ICU stay and hospital stay were lesser in group L (12.75 ± 9.69, 35.95 ± 12.11, 119.10 ± 46.397 vs 23.60 ± 22.03, 51.20 ± 29.92, 140.20 ± 52.65 hours).
The incidence of LCOS was lesser in those patients treated with levosimendan, when compared with those treated with milrinone. Cardiac index and stroke volume index were comparable between the two groups. Thus, levosimendan provides a non-inferior alternative to milrinone when used as the primary inotrope following pediatric cardiac surgery.
米力农通常被用于预防儿科心脏手术后的低心排血量综合征（LCOS）。本研究比较了左西孟旦和米力农在儿科心脏手术后作为主要正性肌力药的使用。
在研究期间，40 名接受先天性心脏病矫正手术的婴儿被招募并随机分为两组（L 组和 M 组）。在复温过程中，给予左西孟旦或米力农负荷剂量，然后输注所选正性肌力药 24 小时。术后测量超声心动图变量。使用 SPSS-20 计算机包进行统计分析。通过独立 t 检验发现变量之间的关联。P<0.05 被认为具有统计学意义。
L 组患者的平均年龄和体重为 8.55±5.83 个月和 6.05±2.09 公斤，而 M 组患者的平均年龄和体重为 6.85±3.57 个月和 5.26±2.11 公斤。4 名（20%）接受左西孟旦治疗的患者发生 LCOS，而 6 名（30%）接受米力农治疗的患者发生 LCOS。两组 L 和 M 的超声心动图参数相似（心指数 3.47±0.76 与 3.72±1.05 L/min/m，射血分数 66.10±7.82%与 59.34±10.74%，每搏量指数 25.4±6.3 与 27.74±10.35 mL/m）。L 组的通气时间、ICU 住院时间和住院时间均较短（12.75±9.69、35.95±12.11、119.10±46.397 与 23.60±22.03、51.20±29.92、140.20±52.65 小时）。
与米力农治疗相比，接受左西孟旦治疗的患者 LCOS 的发生率较低。两组之间的心指数和每搏量指数相似。因此，左西孟旦在儿科心脏手术后作为主要正性肌力药使用时，是米力农的非劣效替代药物。
