左西孟旦对机械辅助循环支持机构间注册系统（INTERMACS）评分低的患者全身灌注的影响：来自台湾单中心的经验
Effects of Levosimendan on Systemic Perfusion in Patients with Low Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Score: Experience from a Single Center in Taiwan.
作者信息
Wang Ying-Hsiang, Chen Jia-Lin, Tsai Chien-Sung, Tsai Yi-Ting, Lin Chih-Yuan, Ke Hong-Yan, Hsu Po-Shun
机构信息
Division of Cardiovascular Surgery, Department of Surgery.
Department of Anesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
出版信息
Acta Cardiol Sin. 2021 Sep;37(5):512-521. doi: 10.6515/ACS.202109_37(5).20210310B.
BACKGROUND
Patients with cardiogenic shock have a high risk of mortality. Intravenous levosimendan can provide pharmacologic inotrope support.
OBJECTIVES
We aimed to investigate the effect of levosimendan in patients with extremely severe cardiogenic shock and low Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score with or without mechanical circulatory support.
METHODS
From January 2017 to May 2019, 24 patients with INTERMACS 1-4 were enrolled in this retrospective study. All patients had systemic malperfusion and were treated with levosimendan. Biochemistry data related to systemic perfusion were recorded and compared before and at 24 and 72 hours after levosimendan administration. Echocardiography and Kansas City Cardiomyopathy Questionnaire (KCCQ) were completed 2 months later to assess left ventricular ejection fraction (LVEF) and quality of life (QoL), respectively.
RESULTS
Arterial pressure and heart rate did not significantly differ before and after levosimendan administration. Atrial fibrillation and ventricular premature complex increased without significance. The dose of inotropes could be significantly tapered down. There were no significant differences in blood urea nitrogen, creatinine, and lactate levels. Urine output significantly increased (p = 0.018), and liver-related enzymes improved but without significance. B-type natriuretic peptide significantly decreased (p = 0.007) at 24 hours after levosimendan administration. Echocardiography showed significantly improved LVEF 2 months later (22.43 ± 8.13% to 35.87 ± 13.4%, p = 0.001). KCCQ showed significantly improved physical activity and greater relief of symptoms (p = 0.003). The survival-to-discharge rate was 75%.
CONCLUSIONS
We observed a decrease in B-type natriuretic peptide, better urine output, and alleviated hepatic injury in the levosimendan group. Most patients who survived without transplantation had significantly improved LVEF and better QoL after levosimendan administration.
背景
心源性休克患者死亡率高。静脉注射左西孟旦可提供药物性正性肌力支持。
目的
我们旨在研究左西孟旦对机械循环支持机构间注册系统（INTERMACS）评分极低且伴有或不伴有机械循环支持的极重度心源性休克患者的影响。
方法
2017年1月至2019年5月，24例INTERMACS 1 - 4级患者纳入本回顾性研究。所有患者均有全身灌注不良，并接受左西孟旦治疗。记录并比较左西孟旦给药前、给药后24小时和72小时与全身灌注相关的生化数据。2个月后完成超声心动图检查和堪萨斯城心肌病问卷（KCCQ），分别评估左心室射血分数（LVEF）和生活质量（QoL）。
结果
左西孟旦给药前后动脉压和心率无显著差异。房颤和室性早搏增加但无统计学意义。正性肌力药物剂量可显著下调。血尿素氮、肌酐和乳酸水平无显著差异。尿量显著增加（p = 0.018），肝脏相关酶有所改善但无统计学意义。左西孟旦给药后24小时B型利钠肽显著降低（p = 0.007）。2个月后超声心动图显示LVEF显著改善（从22.43±8.13%提高到35.87±13.4%，p = 0.001）。KCCQ显示身体活动显著改善，症状缓解更明显（p = 0.003）。出院生存率为75%。
结论
我们观察到左西孟旦组B型利钠肽降低、尿量改善、肝损伤减轻。大多数未接受移植而存活的患者在使用左西孟旦后LVEF显著改善，生活质量更好。
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