左西孟旦对心脏外科术后因左心功能不全应用主动脉内球囊反搏患者预后的影响
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摘要
目的探讨左西孟旦对心脏外科术后因左心功能不全应用主动脉内球囊反搏(IABP)患者预后的影响。方法收集2015年7月至2017年3月首都医科大学附属北京安贞医院心脏外科术后24 h内出现左心功能不全应用IABP的205例患者的临床资料进行回顾性分析。依据是否应用左西孟旦分为左西孟旦组(90例)和对照组(115例)。经倾向性评分匹配,比较2组患者的住院病死率、机械通气时间、IABP辅助时间、住院时间等。结果经倾向性评分匹配后,共有128例患者纳入研究(2组各64例)。左西孟旦组与对照组间主要终点住院病死率比较,无论倾向性评分匹配前[21. 1%(19/90)比27. 8%(32/115)]还是匹配后[21. 9%(14/64)比21. 9%(14/64)],差异均无统计学意义(均P> 0. 05)。经倾向性评分匹配后次要终点比较,左西孟旦组的机械通气时间、IABP辅助时间均明显短于对照组[(134±119) h比(254±271) h、(5±2) d比(7±4) d],差异均有统计学意义(均P <0. 05)。然而,住院时间以及术后并发症发生率在2组间差异无统计学意义(P> 0. 05)。结论左西孟旦不能降低心脏外科术后左心功能不全应用IABP辅助患者的住院病死率,但可以缩短患者的机械通气时间及IABP辅助时间。
Objective To investigate the effect of levosimendan on patients with left heart dysfunction supported by intra-aortic balloon pump( IABP) after cardiac surgery. Methods Clinical data of 205 patients who had left heart dysfunction within 24 hours after cardiac surgery supported by IABP in Beijing Anzhen Hospital,Capital Medical University from July 2015 to March 2017 were retrospectively analyzed. The patients were divided into levosimendan group( n = 90) and control group( n = 115). In-hospital mortality,mechanical ventilation time,IABP time and hospitalization time were analyzed. Results After propensity score matching,128 patients were finally included,with 64 cases in each group. There was no significant difference of in-hospital mortality between groups before and after propensity score matching[21. 1%( 19/90) vs 27. 8%( 32/115),21. 9%( 14/64) vs21. 9%( 14/64) ]( P > 0. 05). After propensity score matching,mechanical ventilation time and IABP time in levosimendan group were significantly shorter than those in control group[( 134 ± 119) h vs( 254 ± 271) h,( 5 ±2) d vs( 7 ± 4) d]( P < 0. 05). Hospitalization time and postoperative complication rate showed no significant difference between groups( P > 0. 05). Conclusion Levosimendan can not reduce the in-hospital mortality in patients with left heart dysfunction supported by IABP after cardiac surgery,but the mechanical ventilation time and IABP use time can be shortened.
Objective To investigate the effect of levosimendan on patients with left heart dysfunction supported by intra-aortic balloon pump( IABP) after cardiac surgery. Methods Clinical data of 205 patients who had left heart dysfunction within 24 hours after cardiac surgery supported by IABP in Beijing Anzhen Hospital,Capital Medical University from July 2015 to March 2017 were retrospectively analyzed. The patients were divided into levosimendan group( n = 90) and control group( n = 115). In-hospital mortality,mechanical ventilation time,IABP time and hospitalization time were analyzed. Results After propensity score matching,128 patients were finally included,with 64 cases in each group. There was no significant difference of in-hospital mortality between groups before and after propensity score matching[21. 1%( 19/90) vs 27. 8%( 32/115),21. 9%( 14/64) vs21. 9%( 14/64) ]( P > 0. 05). After propensity score matching,mechanical ventilation time and IABP time in levosimendan group were significantly shorter than those in control group[( 134 ± 119) h vs( 254 ± 271) h,( 5 ±2) d vs( 7 ± 4) d]( P < 0. 05). Hospitalization time and postoperative complication rate showed no significant difference between groups( P > 0. 05). Conclusion Levosimendan can not reduce the in-hospital mortality in patients with left heart dysfunction supported by IABP after cardiac surgery,but the mechanical ventilation time and IABP use time can be shortened.
引文
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[12]de Jong MM,Lorusso R,Al Awami F,et al.Vascular complications following intra-aortic balloon pump implantation:an updated review[J].Perfusion,2018,33(2):96-104.DOI:10.1177/0267659117727825.
[13]Mao CT,Wang JL,Chen DY,et al.Benefits of intraaortic balloon support for myocardial infarction patients in severe cardiogenic shock undergoing coronary revascularization[J].PLo S One,2016,11(8):e0160070.DOI:10.1371/journal.pone.0160070.
[14]Zheng XY,Wang Y,Chen Y,et al.The effectiveness of intra-aortic balloon pump for myocardial infarction in patients with or without cardiogenic shock:a meta-analysis and systematic review[J].BMCCardiovasc Disord,2016,16(1):148.DOI:10.1186/s12872-016-0323-2.
[15]Tavares-Silva M,Alaa M,Leite S,et al.Dose-response head-to-head comparison of inodilators dobutamine,milrinone,and levosimendan in chronic experimental pulmonary hypertension[J].J Cardiovasc Pharmacol Ther,2017,22(5):485-495.DOI:10.1177/1074248417696818.
[16]Sunny,Yunus M,Karim HM,et al.Comparison of levosimendan,milrinone and dobutamine in treating low cardiac output syndrome following valve replacement surgeries with cardiopulmonary bypass[J].J Clin Diagn Res,2016,10(12):UC05-UC08.DOI:10.7860/JCDR/2016/23584.8987.
[17]Toller W,Heringlake M,Guarracino F,et al.Preoperative and perioperative use of levosimendan in cardiac surgery:European expert opinion[J].Int J Cardiol,2015(184):323-336.DOI:10.1016/j.ijcard.2015.02.022.
[18]Pollesello P,Parissis J,Kivikko M,et al.Levosimendan metaanalyses:Is there a pattern in the effect on mortality?[J].Int JCardiol,2016(209):77-83.DOI:10.1016/j.ijcard.2016.02.014.
[19]Desai PM,Sarkar MS,Umbarkar SR.Prophylactic preoperative levosimendan for off-pump coronary artery bypass grafting in patients with left ventricular dysfunction:single-centered randomized prospective study[J].Ann Card Anaesth,2018,21(2):123-128.DOI:10.4103/aca.ACA_178_17.
[20]Silvetti S,Nieminen MS.Repeated or intermittent levosimendan treatment in advanced heart failure:an updated meta-analysis[J].Int J Cardiol,2016(202):138-143.DOI:10.1016/j.ijcard.2015.08.188.
[21]Cholley B,Caruba T,Grosjean S,et al.Effect of levosimendan on low cardiac output syndrome in patients with low ejection fraction undergoing coronary artery bypass grafting with cardiopulmonary bypass:the licorn randomized clinical trial[J].JAMA,2017,318(6):548-556.DOI:10.1001/jama.2017.9973.
[22]Mehta RH,Leimberger JD,van Diepen S,et al.Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery[J].N Engl J Med,2017,376(21):2032-2042.DOI:10.1056/NEJ-Moa1616218.
[23]Sanfilippo F,Knight JB,Scolletta S,et al.Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery:a systematic review and meta-analysis[J].Crit Care,2017,21(1):252.DOI:10.1186/s13054-017-1849-0.
[24]Chen QH,Zheng RQ,Lin H,et al.Effect of levosimendan on prognosis in adult patients undergoing cardiac surgery:a metaanalysis of randomized controlled trials[J].Crit Care,2017,21(1):253.DOI:10.1186/s13054-017-1848-1.
[25]Landoni G,Lomivorotov VV,Alvaro G,et al.Levosimendan for hemodynamic support after cardiac surgery[J].N Engl J Med,2017,376(21):2021-2031.DOI:10.1056/NEJMoa1616325.
[26]Landoni G,Mizzi A,Biondi-Zoccai G,et al.Reducing mortality in cardiac surgery with levosimendan:a meta-analysis of randomized controlled trials[J].J Cardiothorac Vasc Anesth,2010,24(1):51-57.DOI:10.1053/j.jvca.2009.05.031.
[27]Landoni G,Biondi-Zoccai G,Greco M,et al.Effects of levosimendan on mortality and hospitalization.A meta-analysis of randomized controlled studies[J].Crit Care Med,2012,40(2):634-646.DOI:10.1097/CCM.0b013e318232962a.
[28]Harrison RW,Hasselblad V,Mehta RH,et al.Effect of levosimendan on survival and adverse events after cardiac surgery:a meta-analysis[J].J Cardiothorac Vasc Anesth,2013,27(6):1224-1232.DOI:10.1053/j.jvca.2013.03.027.
[2]Desai AS,Jarcho JA.Levosimendan for the low cardiac output syndrome after cardiac surgery[J].N Engl J Med,2017,376(21):2076-2078.DOI:10.1056/NEJMe1705455.
[3]Lomivorotov VV,Efremov SM,Kirov MY,et al.Low-cardiac-output syndrome after cardiac surgery[J].J Cardiothorac Vasc Anesth,2017,31(1):291-308.DOI:10.1053/j.jvca.2016.05.029.
[4]Manji RA,Arora RC,Singal RK,et al.Early rehospitalization after prolonged intensive care unit stay post cardiac surgery:outcomes and modifiable risk factors[J].J Am Heart Assoc,2017,6(2):e004072.DOI:10.1161/JAHA.116.004072.
[5]Moiseyev VS,P7der P,Andrejevs N.Safety and efficacy of a novel calcium sensitizer,levosimendan,in patients with left ventricular failure due to an acute myocardial infarction.A randomized,placebocontrolled,double-blind study(RUSSLAN)[J].Eur Heart J,2002,23(18):1422-1432.
[6]Schumann J,Henrich EC,Strobl H,et al.Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome[J].Cochrane Database Syst Rev,2018(1):CD009669.DOI:10.1002/14651858.CD009669.pub3.
[7]Ihdayhid AR,Chopra S,Rankin J.Intra-aortic balloon pump:Indications,efficacy,guidelines and future directions[J].Curr Opin Cardiol,2014,29(4):285-292.DOI:10.1097/HCO.0000000000000075.
[8]Suzanne DW,Steffen D,Ingo E.Intra-aortic balloon counterpulsationbasic principles and clinical evidence[J].Vascular pharmacology,2014,60(2):52-56.
[9]Kantrowitz A.Experimental augmentation of coronary flow by retardation of the arterial pressure pulse[J].Surgery,1953,34(4):678-687.
[10]Parissis H,Soo A,Al-Alao B,et al.Intra-aortic balloon pump(IABP):from the old trends and studies to the current"extended"indications of its use[J].J Cardiothorac Surg,2012(7):128.DOI:10.1186/1749-8090-7-128.
[11]Bonios MJ,Pierrakos CN,Argiriou M,et al.Increase in coronary blood flow by intra-aortic balloon counterpulsation in a porcine model of myocardial reperfusion[J].Int J Cardiol,2010,138(3):253-260.DOI:10.1016/j.ijcard.2008.08.015.
[12]de Jong MM,Lorusso R,Al Awami F,et al.Vascular complications following intra-aortic balloon pump implantation:an updated review[J].Perfusion,2018,33(2):96-104.DOI:10.1177/0267659117727825.
[13]Mao CT,Wang JL,Chen DY,et al.Benefits of intraaortic balloon support for myocardial infarction patients in severe cardiogenic shock undergoing coronary revascularization[J].PLo S One,2016,11(8):e0160070.DOI:10.1371/journal.pone.0160070.
[14]Zheng XY,Wang Y,Chen Y,et al.The effectiveness of intra-aortic balloon pump for myocardial infarction in patients with or without cardiogenic shock:a meta-analysis and systematic review[J].BMCCardiovasc Disord,2016,16(1):148.DOI:10.1186/s12872-016-0323-2.
[15]Tavares-Silva M,Alaa M,Leite S,et al.Dose-response head-to-head comparison of inodilators dobutamine,milrinone,and levosimendan in chronic experimental pulmonary hypertension[J].J Cardiovasc Pharmacol Ther,2017,22(5):485-495.DOI:10.1177/1074248417696818.
[16]Sunny,Yunus M,Karim HM,et al.Comparison of levosimendan,milrinone and dobutamine in treating low cardiac output syndrome following valve replacement surgeries with cardiopulmonary bypass[J].J Clin Diagn Res,2016,10(12):UC05-UC08.DOI:10.7860/JCDR/2016/23584.8987.
[17]Toller W,Heringlake M,Guarracino F,et al.Preoperative and perioperative use of levosimendan in cardiac surgery:European expert opinion[J].Int J Cardiol,2015(184):323-336.DOI:10.1016/j.ijcard.2015.02.022.
[18]Pollesello P,Parissis J,Kivikko M,et al.Levosimendan metaanalyses:Is there a pattern in the effect on mortality?[J].Int JCardiol,2016(209):77-83.DOI:10.1016/j.ijcard.2016.02.014.
[19]Desai PM,Sarkar MS,Umbarkar SR.Prophylactic preoperative levosimendan for off-pump coronary artery bypass grafting in patients with left ventricular dysfunction:single-centered randomized prospective study[J].Ann Card Anaesth,2018,21(2):123-128.DOI:10.4103/aca.ACA_178_17.
[20]Silvetti S,Nieminen MS.Repeated or intermittent levosimendan treatment in advanced heart failure:an updated meta-analysis[J].Int J Cardiol,2016(202):138-143.DOI:10.1016/j.ijcard.2015.08.188.
[21]Cholley B,Caruba T,Grosjean S,et al.Effect of levosimendan on low cardiac output syndrome in patients with low ejection fraction undergoing coronary artery bypass grafting with cardiopulmonary bypass:the licorn randomized clinical trial[J].JAMA,2017,318(6):548-556.DOI:10.1001/jama.2017.9973.
[22]Mehta RH,Leimberger JD,van Diepen S,et al.Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery[J].N Engl J Med,2017,376(21):2032-2042.DOI:10.1056/NEJ-Moa1616218.
[23]Sanfilippo F,Knight JB,Scolletta S,et al.Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery:a systematic review and meta-analysis[J].Crit Care,2017,21(1):252.DOI:10.1186/s13054-017-1849-0.
[24]Chen QH,Zheng RQ,Lin H,et al.Effect of levosimendan on prognosis in adult patients undergoing cardiac surgery:a metaanalysis of randomized controlled trials[J].Crit Care,2017,21(1):253.DOI:10.1186/s13054-017-1848-1.
[25]Landoni G,Lomivorotov VV,Alvaro G,et al.Levosimendan for hemodynamic support after cardiac surgery[J].N Engl J Med,2017,376(21):2021-2031.DOI:10.1056/NEJMoa1616325.
[26]Landoni G,Mizzi A,Biondi-Zoccai G,et al.Reducing mortality in cardiac surgery with levosimendan:a meta-analysis of randomized controlled trials[J].J Cardiothorac Vasc Anesth,2010,24(1):51-57.DOI:10.1053/j.jvca.2009.05.031.
[27]Landoni G,Biondi-Zoccai G,Greco M,et al.Effects of levosimendan on mortality and hospitalization.A meta-analysis of randomized controlled studies[J].Crit Care Med,2012,40(2):634-646.DOI:10.1097/CCM.0b013e318232962a.
[28]Harrison RW,Hasselblad V,Mehta RH,et al.Effect of levosimendan on survival and adverse events after cardiac surgery:a meta-analysis[J].J Cardiothorac Vasc Anesth,2013,27(6):1224-1232.DOI:10.1053/j.jvca.2013.03.027.