rh-BNP联合左西孟旦对老年脓毒症患者心肌功能障碍的临床疗效及安全性评价

目的 老年脓毒症患者更易合并心肌功能障碍,本课题评价老年脓毒症合并心肌功能障碍(sepsis-induced myocardial dysfunction, SIMD)患者静脉注射重组人脑钠肽(recombinant human brain natriuretic peptide, rh-BNP)联合左西孟旦的临床疗效...

Efficacy and safety of rh-BNP combined with levosimendan in treatment of elderly patients with sepsis-induced myocardial dysfunction

Objective Elderly patients with sepsis are more likely to be complicated with myocardial dysfunction. To evaluated the clinical efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) combined with levosimendan in treatment of elderly patients with sepsis-induced myocarsfunction(SIMD). Methods One hundred and twenty SIMD patients aged 65-102 years admitted from June 2018 to December 2020 were enrolled in the study. Patients were randomly divided into three groups: patients in control group(n=30) received basic treatment including removal of infected lesions, anti-infection, fluid resuscitation, vasoactive drug administration, and mechanical; those in leosimendan group(n=42) and combined treatment group(n=48) received leosimendan or rh-BNP combined with leosimendan in addition to basic treatment. The cardiac function indicators, inflammatory indicators, drug safety indicators and prognostic indicators were compared among 3 groups after 7 days of treatment. The prognostic indexes were also compared among different subgroups. Results After 7 days of treatment, the reduction of cardiac function indexes and inflammatory indexes in the combined treatment group were significantly higher than those in the control group and levosimendan group(P<0.05). While there was no significant difference in drug safety index among the three groups(P>0.05).There were no significant differences in SOFA score and 28-day mortality among the three groups(P>0.05). In subgroup analysis, there were significant differences in prognostic indexes among the high troponin level subgroups(P<0.05). Conclusion Intravenous injection of rh-BNP combined with levosimendan can significantly improve cardiac function and inhibit inflammatory response in elderly patients with SIMD, and slow down the process of multiple organ failure(MOF) with high safety.