预防性应用左西孟旦对左心室功能障碍患者非体外循环冠状动脉旁路移植术后早期心肌功能的影响

背景非体外循环冠状动脉旁路移植术(OPCABG)是目前临床治疗严重冠状动脉病变的主要手术方式,而减轻OPCABG后早期心肌缺血再灌注损伤有利于改善心肌功能、减少术后并发症的发生。目的探讨预防性应用左西孟旦对左心室功能障碍患者OPCABG后早期心肌功能的影响。方法选取保定市第一中心医院2019年6月至2021年6月收治的行OPCABG的左心室功能障碍患者48例,根据随机数字表法分为对照组16例和试验组32例。行OPCABG前,对照组采用标准治疗,试验组在对照组基础上于OPCABG前24 h应用左西孟旦注射液。比较两组患者术前及术后48 h生命体征[体温(T)、心率(HR)、收缩压(SBP)、舒张压(DBP)]、左心功能[左心室射血分数(LVEF)]及实验室检查指标[乳酸(Lac)、血肌酐(Scr)、血尿素氮(BUN)、白细胞计数(WBC)、血红蛋白(HGB)、中性粒细胞百分比(NEUT%)],术前及术后1、6、12、48 h心肌功能指标[高敏肌钙蛋白I(hsTnI)、肌酸激酶同工酶(CK-MB)、B型脑钠肽(BNP)],手术及预后情况。结果试验组患者术后48 h WBC、NEUT%低于对...

Effect of Preventive Application of Levosimendan on Early Myocardial Function after Off-pump Coronary Artery Bypass Grafting in Left Ventricular Dysfunction Patients

Backgroud Off-pump coronary artery bypass grafting(OPCABG)is the primary surgical method for the clinical treatment of severe coronary artery disease,reducing early myocardial ischemia-reperfusion injury after OPCABG is conducive to improve myocardial function and reduce postoperative complications.Objective To discuss the effect of preventive application of levosimendan on early myocardial function after OPCABG in left ventricular dysfunction patients.Methods A total of 48 patients with left ventricular dysfunction undergoing OPCABG in Baoding No.1 Central Hospital from June 2019 to June 2021 were selected,and divided into 16 cases in the control group and 32 cases in the experimental group according to random number table method.Patients in the control group were given standard treatment before operation,and patients in the experimental group were given levosimendan injection 24 hours before operation on the basis of the control group.Vital signs[temperature(T),heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)],left ventricular function[left ventricular ejection fraction(LVEF)]and laboratory examination indexes[lactic acid(Lac),serum creatinine(Scr),blood urea nitrogen(BUN),white blood cell count(WBC),hemoglobin(HGB)and percentage of neutrophils(NEUT%)]before operation and at 48 hours after operation,myocardial function indexes[high sensitivity troponin I(hs-TnI),creatine kinase isoenzyme(CK-MB),B-type natriuretic peptide(BNP)]before operation and at 1,6,12,48 hours after operation,condition of operation and prognosis were compared between the two groups.Results WBC and NEUT%at 48 hours after operation in the experimental group were lower than those in the control group(P<0.05).Levels of hs-TnI,CK-MB and BNP at 1,6 hours after operation in the experimental group were lower than those in the control group(P<0.05).Levels of hs-TnI,CK-MB and BNP at 1,6,12 and 48 hours after operation in the control group were higher than those before operation,respectively(P<0.05);level of hs-TnI at 6,12,48 hours after operation,level of CK-MB at 1,6,12,48 hours after operation,level of BNP at 12,48 hours after operation in the experimental group were higher than those before operation,respectively(P<0.05).Levels of hs-TnI,CK-MB at 6 hours after operation in the control group were higher than those at 1 hour after operation,respectively(P<0.05);hs-TnI level at 6,12 hours after operation,CK-MB level at 6 hours after operation,and BNP level at 12,48 hours after operation in the experimental group were higher than those at 1 hour after operation,respectively(P<0.05).CK-MB level at 48 hours after operation in the control group was lower than that at 6 hours after operation,respectively(P<0.05);hs-TnI level at 48 hours after operation and level of CK-MB at 12,48 hours after operation in the experimental group were lower than those at 6 hours after operation,BNP level at 12,48 hours after operation was higher than that at 6 hours after operation,respectively(P<0.05).Incidence of low cardiac output syndrome(LCOS)in the experimental group was lower than that in the control group(P<0.05).Conclusion Preventive application of levosimendan can effectively alleviate the early myocardial injury and inflammatory reaction after OPCABG in left ventricular dysfunction patients,and reduce the risk of LCOS.