Methods Thirty-eight patients with left ventricular ejective fraction less than 45% related to septic shock after 48 h of fluid resuscitation were randomly divided into the dobutamine group (19 cases) and levosimendan group (19 cases). Patients in the dobutamine group received dobutamine (5 μg·kg-1·min-1) for 24 h after fluid resuscitation, and patients in the levosimendan group were given levosimendan(0.2 μg·kg-1·min-1) for 24 h at the same time. The hemodynamics including heart rate, central venous pressure (CVP), mean arterial pressure (MAP), stroke volume index, cardiac index, left ventricular stroke work index (LVSWI), systemic vascular resistance (SVRI), intrathoracic blood volume index (ITBVI), global end diastolic volume index (GEDI), extravascular lung water index (EVLWI), oxygen delivery index (DO2I), oxygen consumption index (VO2I) were detected by pulse indicator continuous cardiac output (PiCCO), and the levels of human heart-type fatty acid binding protein (h-FABP), troponin I (TNI), brain natriuretic peptide, LVEF and blood lactic acid were recorded before and 24 h after treatment in the two groups. Meanwhile, mechanical ventilation time, length of stay in ICU and hospital, 28-day mortality were also compared between the two groups.
Results The heart rate (t=0.984, P=0.332), CVP (t=0.979, P=0.334), MAP (t=0.301, P=0.765), stroke volume index (t=0.320, P=0.750), cardiac index (t=1.209, P=0.235), LVSWI (t=1.306, P=0.200), SVRI (t=1.365, P=0.181), ITBVI (t=0841, P=0.406), GEDI (t=0.706, P=0.484), EVLWI (t=0.167, P=0.869), DO2I (t=0.467, P=0.644), VO2I (t=0.485, P=0.631), h-FABP (t=1.462, P=0.152), TNI (t=0.397, P=0.693), brain natriuretic peptide (t=0.302, P=0.764), LVEF (t=0.494, P=0.624) and blood lactic acid (t=1.071, P=0.291) all showed no significant differences before and after the treatment. Compared with the dobutamine group, the levels of SVI [(34 ± 10) ml/m2 vs. (40 ± 9) ml/m2, t=2.261, P=0.030], cardiac index [(3.1 ± 0.4) L·min-1·m-2 vs. (3.5 ± 0.3) L·min-1·m-2, t=3.487, P=0.001], LVSWI [(33.8 ± 2.9) kg·min-1·m-2 vs. (36.9 ± 2.7) kg·min-1·m-2, t=3.410, P=0.002], DO2I [(720 ± 50) kg·min-1·m-2 vs. (755 ± 52) kg·min-1·m-2, t=2.133, P=0.040], VO2I [(127 ± 15) kg·min-1·m-2 vs. (140 ± 18) kg·min-1·m-2, t=2.241, P=0.031], LVEF [(39 ± 8)% vs. (46 ± 8)%, t=2.485, P=0.018] increased obviously, and the EVLWI [(8.9 ± 3.0) ml/kg vs. (6.4 ± 2.8) ml/kg, t=2.665, P=0.012], h-FABP[(13.1 ± 3.8) μg/L vs. (8.5 ± 2.6) μg/L, t=4.355, P<0.001], TNI[(0.28 ± 0.10) μg/L vs. (0.20 ± 0.11) μg/L, t=2.346, P=0.025], brain natriuretic peptide [(381 ± 49) ng/L vs. (233 ± 39) ng/L, t=10.380, P<0.001] and blood lactic acid [(4.3 ± 1.0) mmol/L vs. (3.6 ± 0.8) mmol/L, t=2.383, P=0.022] decreased markedly after the treatment. However, there were no significant differences in the mechanical ventilation time, length of stay in ICU and hospital, 28-day mortality between the two groups (t=0.171, 0.209, 0.290, 0.117, all P>0.05).