左西孟旦联合肾上腺素治疗三尖瓣成形术后合并右心室功能不全患者的临床疗效

目的 观察左西孟旦联合肾上腺素应用于三尖瓣病变合并右心室功能不全患者的临床疗效.方法 2012年6月至2013年7月,共收集风湿性三尖瓣关闭不全且施行了三尖瓣成形手术的患者60例.患者术后均有不同程度的右心室功能不全,主要表现为循环不稳,中心静脉压持续上升（≥15 mm Hg,1 mm Hg=0.133 kPa）,尿量减少（≤40 mL/h）,心排血量（CO）降低≤2.0 L/（rain·m2）,]床边心脏超声检查结果：排除心包填塞,右心室收缩无力.将患者按电脑随机数字表法分为两组：A组为使用肾上腺素＋左西孟旦组30例,B组为肾上腺素组30例.观察两组患者72 h内的血压、尿量、中心静脉压、心排血量、脑钠肽浓度等数据的变化及术后28 d生存情况.结果 A组血压、尿量、中心静脉压、心排血量、脑钠肽浓度等数据的变化及术后28 d生存情况均优于B组,差异有统计学意义（P＜0.05）.且A组治疗有效率为65.2％,B组治疗有效率为45.7％,两组比较差异有统计学意义（P＜0.05）.以术后28 d为观察终点,60例患者存活51例,死亡9例,其中A组死亡3例,B组死亡6例.结论 左西孟旦在治疗三尖瓣成形术后伴右心室功能不全患者的疗效较传统的治疗具有显著的优势.

Effect of levosimendan combined with epinephrine in therapy for patients with right ventricular dysfunction after tricuspid annuloplasty

Objectives To observe the clinic effect of levosimendan combined with epinephrine in therapy for patients with right ventricular dysfunction after tricuspid annuloplasty.Methods This study was a prospective observational study.Totally 60 patients undergoing tricuspid annuloplasty surgery during June 2012 and July 2013 were included.These patients had different degrees of right ventricular dysfunction which was defined as：circulation was unstable,central venous pressure （CVP） was continuously ascending （≥ 15 mm Hg,1 mm Hg=0.133 kPa）,urine volume was descending （≤40 mL/h） and cardiac output （CO） was descending ≤2.0 L/（min·m2）].Bedside echocardiogram displayed no cardiac tamponade or right ventricular dysfunction.Patients were randomly divided into two groups：30 patients used epinephrine and levosimendan were in A group;30 patients used epinephrine only were in B group.Blood pressure （BP）,urine volume,CVP,CO,brain natriuretic peptide （BNP） in 72 h and survival status in 28 days of the two groups were recorded and compared.Results BP,urine volume,CVP,CO,BNP and survival status in 28 days in A group were significantly better than those in B group （P〈0.05）.Effective rate in A group was also obviously higher than that in B group（65.2% vs.45.7%,P〈0.05）.At the endpoint of the observation （28 days after surgery）,51 patients survived,9 patients died （3 in A group and 6 in B group）.Conclusions Levosimendan in therapy for patients with right ventricular dysfunction after tricuspid annuloplasty is superior to traditional therapy.