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首页> 外文期刊>The Open Anesthesiology Journal >Levosimendan Versus Milrinone in the Management of Impaired Left Ventricular Function in Patients Undergoing Coronary Artery Bypass Graft Surgery
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Levosimendan Versus Milrinone in the Management of Impaired Left Ventricular Function in Patients Undergoing Coronary Artery Bypass Graft Surgery

机译：左西孟旦与米力农治疗冠状动脉搭桥术患者左心功能受损

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Background: Patients undergoing cardiac surgery are at risk of postcardiotomy myocardial dysfunction. This condition causes delayed recovery, organ failure, prolonged intensive care unit and hospital stays, and an increased risk of mortality; these patients often require inotropic agent support. Levosimendan is a calcium sensitizer with a unique mechanism of action, binding to cardiac troponin C and enhancing myofilament responsiveness to calcium, increasing myocardial contraction without increasing myocardial oxygen consumption. Phosphodiesterase III inhibitors such as milrinone provide an alternative means of inotropic support by increasing the concentration of cyclic AMP and intracellular calcium. They also have vasodilatory effects. Objective: The aim of this study was the comparison between levosimendan versus milrinone regarding their effects on the hemodynamics, need for additional mechanical (intra aortic balloon pump) or pharmacological support to the heart, weaning from mechanical ventilation and duration of intensive care unit stay for patients after Off-Pump Coronary Artery Bypass Graft (OPCABG) surgery suffering from impaired left ventricular function (preoperative ejection fraction ≤ 40%). Methods: 60 patients between 40 and 70 years of both sexes with impaired left ventricular function (ejection fraction ≤ 40%), New York Heart Association (NYHA III IV), undergoing elective Off-Pump Coronary Artery Bypass Graft (OPCABG) surgery were selected for this study. After induction of anesthesia, patients were randomly assigned to one of two equal groups each containing 30 patients: Group L (Levosimendan group) included patients who received levosimendan 0.1- 0.2 μg/kg/min. Started immediately with the induction of anesthesia. Group M (Milrinone group) included patients who received milrinone 0.4-0.6 μg/kg/min. Started immediately with the induction of anesthesia. In both groups, norepinephrine was titrated (8 mg norepinephrine in 50 ml saline) to keep mean arterial pressure MAP ≥ 70 mmHg. Hemodynamic findings included Preoperative and post ICU discharge ejection fraction, systemic and pulmonary artery pressures, systemic and pulmonary vascular resistance, cardiac output and stroke volume. Also laboratory findings included Serum lactate and Troponin I., in addition, to post operative findings were: Need for intra aortic balloon pump, time of weaning from the ventilator, days of ICU stay and appearance of drug allergy compared in both groups. Results: There was a significant increase in the ejection fraction in both groups that was greater in the levosimendan group. The decrease in pulmonary pressure in the levosimendan group was more significant than milrinone group. There was a gradual decrease in pulmonary and systemic vascular resistance in both groups with a more significant decrease in the levosimendan group. There was a gradual increase in cardiac output and stroke volume in both groups that was greater in the levosimendan group. Serum lactate gradually decreased in both groups with an insignificant difference; there was an increase in serum troponin I level in both groups which was more significant in the milrinone group. Weaning from mechanical ventilation and length of ICU stay was shown to be significantly shorter in time in the levosimendan group. Conclusion: Both levosimendan and milrinone caused a significant increase in cardiac output, stroke volume and ejection fraction, with a decrease in pulmonary and systemic vascular resistance. These effects improved cardiac performance by decreasing afterload and increasing cardiac inotropism. It was noticed that these effects were more significant with levosimendan than milrinone. Also, there was a decrease in ICU stay, mechanical ventilation timing and hospital stay with levosimendan than milrinone which decreased the costs of treatment for the patients.
机译：背景：进行心脏手术的患者有切开心肌功能障碍的风险。这种情况导致恢复迟缓，器官衰竭，重症监护病房和住院时间延长以及死亡风险增加;这些患者通常需要正性肌力药物支持。左西孟旦是一种钙敏化剂，具有独特的作用机制，可与心肌肌钙蛋白C结合并增强对钙的肌丝反应性，增加心肌收缩而不增加心肌耗氧量。磷酸二酯酶III抑制剂（如米力农）通过增加环AMP和细胞内钙的浓度，提供了一种正性肌力支持的替代方法。它们还具有血管舒张作用。目的：本研究的目的是比较左西孟旦和米力农对血流动力学的影响，对心脏是否需要额外的机械（主动脉内球囊泵）或药理支持，机械通气的断奶和重症监护病房住院的持续时间非体外循环冠状动脉搭桥术（OPCABG）手术后左心室功能受损（术前射血分数≤40％）的患者。方法：选择纽约心脏协会（NYHA III IV）接受择期非体外循环冠状动脉搭桥手术（OPCABG）的60名年龄在40至70岁之间的男女，其左心功能受损（射血分数≤40％）这项研究。麻醉诱导后，将患者随机分为两组，每组30名患者：L组（左西孟旦组）包括接受左西孟旦0.1- 0.2μg/ kg / min的患者。立即开始诱导麻醉。 M组（米力农组）包括接受米力农0.4-0.6μg/ kg / min的患者。立即开始诱导麻醉。在两组中，滴定去甲肾上腺素（在50 ml盐水中加入8 mg去甲肾上腺素）以保持平均动脉压MAP≥70 mmHg。血液动力学检查结果包括术前和术后ICU排出射血分数，全身和肺动脉压力，全身和肺血管阻力，心输出量和中风量。实验室检查结果还包括血清乳酸和肌钙蛋白I，此外，术后检查结果包括：两组患者需要主动脉内球囊泵，从呼吸机断奶的时间，ICU停留天数和出现药物过敏的情况。结果：两组的射血分数均显着增加，而左西孟旦组则更高。左西孟旦组的肺压降低比米力农组更为显着。两组的肺和全身血管阻力逐渐降低，而左西孟旦组降低更明显。两组的心输出量和中风量逐渐增加，而左西孟旦组则更大。两组血清乳酸水平逐渐降低，差异无统计学意义。两组的血清肌钙蛋白I水平均升高，在米力农组中更为显着。在左西孟旦组中，机械通气的断奶和ICU住院时间明显缩短。结论：左西孟旦和米力农均引起心输出量，中风量和射血分数的显着增加，而肺和全身血管阻力降低。这些作用通过减少后负荷和增加心脏的肌力来改善心脏的性能。注意到左西孟旦的这些作用比米力农更为显着。此外，左西孟旦的ICU住院时间，机械通气时间和住院时间均比米力农减少，从而降低了患者的治疗费用。

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