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| 左西孟旦联合地高辛对左心室收缩功能减低患者不停跳冠状动脉旁路移植术围术期血流动力学的影响 |
| Effect of levosimendan combined with digoxin on perioperative haemodynamics in patients with left ventricular dysfunction undergoing off-pump coronary artery bypass grafting |
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| DOI：10.12089/jca.2025.03.002 |
| 中文关键词: 左西孟旦 地高辛 不停跳冠状动脉旁路移植术 左心室收缩功能减低 倾向性评分匹配 |
| 英文关键词: Levosimendan Digoxin Off-pump coronary artery bypass grafting Left ventricular dysfunction Propensity score matching |
| 基金项目:国家自然科学基金（82371283）；江苏省人民医院“临床能力提升工程”（JSPH-MC-2020-9） |
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| 中文摘要: |
目的： 探究左西孟旦联合地高辛对左心室收缩功能减低患者不停跳冠状动脉旁路移植术（OPCABG）围术期血流动力学的影响。
方法：回顾性分析2022年11月至2023年10月行OPCABG的左心室收缩功能减低患者396例，男233例，女163例，年龄18～80岁，BMI 18.5～30.0 kg/m2 ，ASA Ⅲ或Ⅳ级。根据围术期是否使用左西孟旦联合地高辛将患者分为两组：联合组（U组，n=68）和对照组（C组，n=328）。两组采用倾向性评分匹配（PSM），共有65对患者匹配成功，比较术前、给药后30 min、钝缘支或右冠血运重建时、术后6、12、24 h 心脏指数（CI）、HR、MAP、肺毛细血管楔压（PCWP）和体循环阻力指数（SVRI），以及术中主动脉内球囊反搏（IABP）使用情况、转心肺转流（CPB）率及钝缘支或右冠血运重建时血管活性药评分（VIS）、术后24 h肌酸激酶同工酶（CK-MB）及肌钙蛋白T（cTnT）浓度、术后机械通气时间、ICU停留时间、术后7 d低心排综合征（LCOS）发生情况和术后7 d IABP使用情况。
结果：与C组比较，U组给药后30 min、钝缘支或右冠血运重建时、术后6、12、24 h CI明显升高（P<0.05），钝缘支或右冠血运重建时、术后6、12、24 h PCWP明显降低（P<0.05），给药后30 min、钝缘支或右冠血运重建时、术后6、12、24 h SVRI明显降低（P<0.05）。钝缘支或右冠血运重建时两组HR和MAP的差异均无统计学意义。与C组比较，U组术中IABP使用率、转CPB率及钝缘支或右冠血运重建时VIS明显降低（P<0.05），术后24 h CK-MB和cTnT浓度明显降低（P<0.05），术后机械通气时间、ICU停留时间明显缩短（P<0.05），术后7 d低心排综合征（LCOS）发生率和术后7 d IABP使用率明显降低（P<0.05）。
结论： 围术期应用左西孟旦联合地高辛可改善左心室收缩功能减低患者OPCABG围术期血流动力学状态，并降低术后心肌损伤和LCOS的发生率。 |
| 英文摘要: |
Objective: To investigate the efficacy of levosimendan combined with digoxin on perioperative haemodynamics in patients with left ventricular dysfunction who undergoing off-pump coronary artery bypass grafting (OPCABG) surgery.
Methods: A total of 396 patients with left ventricular dysfunction underwent OPCABG, 233 males and 163 females, aged 18-80 years, BMI 18.5-30.0 kg/m2 , ASA physical status Ⅲ or Ⅳ, were retrospectively analyzed from November 2022 to October 2023. Depending on whether received levosimendan combined with digoxin during perioperative period, patients were divided into two groups: united treatment group (group U, n = 68) or control group (group C, n = 328). Propensity score matching (PSM) was applied to compared the two groups, 65 patient pairs were matched successfully. Cardiac index (CI), HR, MAP, pulmonary capillary wedge pressure (PCWP), and systemic vascular resistance index (SVRI) were compared preoperatively, 30 minutes after drug administration, at the time of obtuse marginal branch or right coronary haemodilution reconstruction, 6, 12, and 24 hours after surgery. The intraoperative intra-aortic balloon counterpulsation (IABP) utilization, conversion to cardiopulmonary bypass (CPB) rate, vasoactive inotropic score (VIS), the creatine kinase MB and troponin T levels, the postoperative duration of mechanical ventilation and ICU stay time, the incidence of low cardiac output syndrome (LCOS), and the use of IABP within 7 days postoperatively were also compared separately.
Results: Compared with group C, the cardiac index in group U was higher 30 minutes after drug administration, at the time of obtuse marginal branch or right coronary haemodilution reconstruction, 6, 12, and 24 hours after surgery (P < 0.05), the PCWP in group U was lower at the time of obtuse marginal branch or right coronary haemodilution reconstruction, 6, 12, and 24 hours after surgery (P < 0.05), the SVRI in group U was lower 30 minutes before drug administration, at the time of obtuse marginal branch or right coronary haemodilution reconstruction, 6, 12, and 24 hours after surgery (P < 0.05). There was no statistical difference between the two groups in HR and MAP at the time of obtuse marginal branch or right coronary haemodilution reconstruction. Compared with group C, the intraoperative IABP utilization, conversion to CPB rate and VIS in group U were lower at the time of obtuse marginal branch or right coronary haemodilution reconstruction (P < 0.05), the creatine kinase MB and troponin T levels in group U were lower 24 hours after surgery (P < 0.05), the postoperative duration of mechanical ventilation and ICU stay time in group U were lower (P < 0.05), the incidence of LCOS and the use of IABP within 7 days postoperatively in group U were lower (P < 0.05).
Conclusion: For patients with left ventricular dysfunction undergoing OPCABG, perioperative application of levosimendan combined with digoxin can improve the perioperative hemodynamic status and reduce the occurrence of myocardial injury and LCOS postoperatively. |
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