左西孟旦提高困难脱机成功率的前瞻性研究
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摘要
目的:探讨左西孟旦对提高ICU困难脱机患者脱机成功率的有效性。方法:31例困难脱机患者按常规方法治疗(对照组),37例困难脱机患者在常规治疗基础上使用左西孟旦治疗(研究组),比较两组治疗前及治疗7天后BNP、氧合指数及脱机成功率。用多因素分析方法明确排除年龄、病情严重程度、BNP等因素后,左西孟旦对困难脱机患者脱机成功率的影响。结果:研究组脱机成功率明显高于对照组(65.7%vs 35.7%,P<0.05);研究组治疗前后BNP(9150.83±1147.14 ng/L vs 5464.85±907.45 ng/L,P<0.05)、氧合指数(261.82±72.46 vs283.72±99.44,P<0.05),对照组治疗前后BNP(8811.17±1097.21 ng/L vs 8036.07±1046.79 ng/L,P<0.05;氧合指数(264.83±92.99 vs 271.27±138.18,P>0.05)。调整性别、年龄、APACHEⅡ评分、治疗前的BNP、呼吸浅快指数、氧合指数等后,研究组OR值为0.263,P<0.05,降低脱机失败风险73.7%。结论:在常规治疗基础上加用左西孟旦可提高ICU困难脱机患者脱机成功率。
Objective:To explore the role of levosimendan in improving the successful rate of weaning from mechanical ventilation in difficult-to-wean in the intensive care unit(ICU). Methods:Cases of difficult-to-wean were treated with levosimendan(research group,n=37)on the basic of conventional therapy(control group,n=31),the changesof BNP,oxygenation index and the success rate of difficult-to-wean ventilator before and after treatment 7 days betweenthe two groups. After the factors such as age,severity,BNP and other factors were clearly excluded by multifactor analysis,to elevate the effect of levosimendan on the success rate of difficult-to-wean patients. Results:The successful rate ofdifficult-to-wean ventilator in research group was significantly higher than that in the control group(65.7% vs 35.7%,P<0.05). BNP(9150.83±1147.14 ng/L vs 5464.85±907.45 ng/L,P<0.05)and oxygenation index(261.82±72.46 vs 283.72±99.44,P<0.05)in the research group before and after treatment,while BNP(8811.17 ± 1097.21 ng/L vs 8036.07 ±1046.79 ng/L,P<0.05)and oxygenation index(264.83±92.99 vs 271.27±138.18,P>0.05)in the control group. After adjusted for gender,age,APACHE Ⅱ score,BNP before treatment,rapid shallow breathing index and oxygenation index,the value of OR in research group was 0.263,P<0.05,which reduced the risk of weaning failure by 73.7%. Conclusion:The addition of levosimendan on the basis of conventional treatment can improve the successful rate of difficult-to-wean in ICU.
Objective:To explore the role of levosimendan in improving the successful rate of weaning from mechanical ventilation in difficult-to-wean in the intensive care unit(ICU). Methods:Cases of difficult-to-wean were treated with levosimendan(research group,n=37)on the basic of conventional therapy(control group,n=31),the changesof BNP,oxygenation index and the success rate of difficult-to-wean ventilator before and after treatment 7 days betweenthe two groups. After the factors such as age,severity,BNP and other factors were clearly excluded by multifactor analysis,to elevate the effect of levosimendan on the success rate of difficult-to-wean patients. Results:The successful rate ofdifficult-to-wean ventilator in research group was significantly higher than that in the control group(65.7% vs 35.7%,P<0.05). BNP(9150.83±1147.14 ng/L vs 5464.85±907.45 ng/L,P<0.05)and oxygenation index(261.82±72.46 vs 283.72±99.44,P<0.05)in the research group before and after treatment,while BNP(8811.17 ± 1097.21 ng/L vs 8036.07 ±1046.79 ng/L,P<0.05)and oxygenation index(264.83±92.99 vs 271.27±138.18,P>0.05)in the control group. After adjusted for gender,age,APACHE Ⅱ score,BNP before treatment,rapid shallow breathing index and oxygenation index,the value of OR in research group was 0.263,P<0.05,which reduced the risk of weaning failure by 73.7%. Conclusion:The addition of levosimendan on the basis of conventional treatment can improve the successful rate of difficult-to-wean in ICU.
引文
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[11]Hillgaard TK,Andersen A,Andersen S,et al.Levosimendan Prevents Pressure-Overload-induced Right Ventricular Failure[J].J Cardiovasc Pharmacol,2016,67(4):275.
[2]Colombo J.Difficult to wean patients[J].Aust Crit Care,2015,28(3):122.
[3]Mishra A,Kumar B,Dutta V,et al.Comparative Effect of Levosimendan and Milrinone in Cardiac Surgery Patients with Pulmonary Hypertension and Left Ventricular Dysfunction[J].J Cardiothorac Vasc Anesth,2016,30(3):639.
[4]Gong B,Li Z,Yat Wong PC.Levosimendan Treatment for Heart Failure:A Systematic Review and Meta-Analysis[J].J Cardiothorac Vasc Anesth,2015,29(6):1415.
[5]Sterba M,Banerjee A,Mudaliar Y.Prospective observational study of levosimendan and weaning of difficult-towean ventilator dependent intensive care patients[J].Crit Care Resusc,2008,10(3):182.
[6]Daniel Martin A,Smith BK,Gabrielli A.Mechanical ventilation,diaphragm weakness and weaning:a rehabilitation perspective[J].RespirPhysiolNeurobiol,2013,189(2):377.
[7]Doorduin J,Sinderby CA,Beck J,et al.The calcium sensitizer levosimendan improves human diaphragm function[J].Am J Respir Crit Care Med,2012,185(1):90.
[8]Domínguez-Cherit G,Sandoval J.Braz J Med Biol Res.Pulmonary hypertension due to acute respiratory distress syndrome[J].2014,47(10):904.
[9]Tauil KM,Gaio E,Melo-Silva CA,et al.Carvalho RS,Pulmonary arterial hypertension and sepsis:prothrombotic profile and inflammation can changespulmonary mechanics[J].Med Hypotheses,2014,83(3):290.
[10]Hansen MS,Andersen A,Holmboe S,et al.Levosimendan Prevents and Reverts Right Ventricular Failure in Experimental Pulmonary Arterial Hypertension[J].JCardiovasc Pharmacol,2017,70(4):232.
[11]Hillgaard TK,Andersen A,Andersen S,et al.Levosimendan Prevents Pressure-Overload-induced Right Ventricular Failure[J].J Cardiovasc Pharmacol,2016,67(4):275.