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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2017, Vol. 10 ›› Issue (06) : 381 -385. doi: 10.3877/cma.j.issn.1674-6880.2017.06.004

所属专题： 文献；

论著

左西孟旦对应激性心肌病患者的心脏保护作用
陈如杰1, 郭献阳1, 程碧环1,†(), 龚裕强1, 应斌宇1, 杨鹏麟2   
  1. 1. 325027　浙江温州，温州医科大学附属第二医院重症医学科
    2. 325027　浙江温州，温州医科大学附属第二医院心血管内科
  • 收稿日期:2017-02-17 出版日期:2017-12-01
  • 通信作者: 程碧环
  • 基金资助:
    浙江省自然科学基金项目(LY14H150011); 温州市科技局科研基金资助项目(Y20170757)

Cardiac protective effect of levosimendan in patients with tako-tsubo cardiomyopathy

Rujie Chen1, Xianyang Guo1, Bihuan Cheng1,†(), Yuqiang Gong1, Binyu Ying1, Penglin Yang2   

  1. 1. Department of Intensive Care Unit, the 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
    2. Department of Cardiology, the 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
  • Received:2017-02-17 Published:2017-12-01
  • Corresponding author: Bihuan Cheng
  • About author:
    Corresponding author: Cheng Bihuan, Email:
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陈如杰, 郭献阳, 程碧环, 龚裕强, 应斌宇, 杨鹏麟. 左西孟旦对应激性心肌病患者的心脏保护作用[J]. 中华危重症医学杂志(电子版), 2017, 10(06): 381-385.

Rujie Chen, Xianyang Guo, Bihuan Cheng, Yuqiang Gong, Binyu Ying, Penglin Yang. Cardiac protective effect of levosimendan in patients with tako-tsubo cardiomyopathy[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(06): 381-385.

目的

探讨左西孟旦对应激性心肌病（TTC）患者的心脏保护作用。

方法

回顾性研究2006年1月至2016年12月温州医科大学附属第二医院重症医学科收治的应激性心肌病患者31例，按照是否使用左西孟旦分为治疗组（12例）与对照组（19例）。治疗组严格按照说明书使用左西孟旦，初始负荷剂量为6~12 μg/kg，静脉滴注大于10 min，之后持续微泵0.1 μg·kg-1·min-1；对照组未使用左西孟旦。对两组TTC患者的一般资料和心脏相关指标包括左心室射血分数（LVEF）、左心室舒张末期内径（LVDD）、心肌肌钙蛋白I（cTnI）及脑钠肽前体进行比较。同时进行出院随访，平均随访22.3个月，记录患者的长期生存情况。

结果

两组患者的急性病生理学和长期健康评价（APACHE）Ⅱ评分[（18 ± 4）分vs.（16 ± 4）分，t = 2.057，P = 0.049]及ICU住院时间[（16 ± 5）d vs.（21 ± 6）d，t = 2.110，P = 0.044]比较，差异均有统计学意义。治疗组出院时LVEF较对照组有所增高[（59 ± 9）% vs.（52 ± 8）%，t = 2.062，P = 0.048]；而cTnI高峰值[（8.7 ± 3.2）μg/L vs.（11.4 ± 3.6）μg/L，t = 2.120，P = 0.043]及脑钠肽前体高峰值[（3 656 ± 1 043）ng/L vs.（4 753 ± 965）ng/L，t = 2.989，P = 0.006]均较对照组降低。治疗组患者中3例死亡，对照组患者中6例死亡，两组患者总体生存情况比较，差异无统计学意义（P = 0.325）。

结论

左西孟旦可以促进TTC患者心脏功能的恢复，减轻心肌细胞的损伤，缩短ICU住院时间，但对其总体生存情况无影响。

关键词: 左西孟旦, 应激性心肌病, 保护作用
Objective

To investigate the cardiac protective effect of levosimendan in patients with tako-tsubo cardiomyopathy (TTC).

Methods

A total of 31 TTC patients collected from Department of Intensive Care Unit, the 2nd Affiliated Hospital of Wenzhou Medical University from January 2006 to December 2016 were retrospectively studied, who were divided to the treatment group (n = 12) and the control group (n = 19) according to the use of levosimendan. Patients in the treatment group were used levosimendan strictly according to the instructions with the initial loading dose of 6~12 μg/kg through intravenous infusion for more than 10 min, followed by continuous minipump infusion of 0.1 μg·kg-1·min-1. The control group did not use levosimendan. The general data and related cardiac indexes which included the left ventricular ejection fraction (LVEF), the left ventricular end diastolic dimension (LVDD), the cardiac troponin I (cTnI) and the pro-brain natriuretic peptide of TTC patients in the two groups were compared. At the same time, patients were followed up for an average of 22.3 months to record their long-term survival.

Results

The acute physiology and chronic health evaluation (APACHE) Ⅱ scores [(18 ± 4) vs. (16 ± 4), t = 2.057, P = 0.049] and the ICU length of stay [(16 ± 5) d vs. (21 ± 6) d, t = 2.110, P = 0.044] of patients in the two groups were significantly different. The LVEF of patients in the treatment group was higher as compared to the control group [(59 + 9) % vs. (52 + 8) %, t = 2.062, P = 0.048]. The peak values of cTnI [(8.7 ± 3.2) μg/L vs. (11.4 ± 3.6) μg/L, t = 2.120, P = 0.043] and pro-brain natriuretic peptide [(3 656 ± 1 043) ng/L vs. (4 753 ± 965) ng/L, t = 2.989, P = 0.006] in the treatment group were lower than those in the control group. There was no significant difference in the overall survival of the two groups with 3 cases of death in the treatment group and 6 cases of death in the control group (P = 0.325).

Conclusion

Levosimendan has the potential to promote the recovery of cardiac functions, reduce the injury of cardiac myocytes and shorten the ICU length of stay in TTC patients, but it has no effect on their overall survival.

Key words: Levosimendan, Tako-tsubo cardiomyopathy, Protective effect
表1 两组TTC患者一般资料比较（ ± s）
组别 例数 年龄（岁） 性别比（男/女，例） 体质量指数（kg/m2） 吸烟[例（%）] 高血压病[例（%）] 糖尿病[例（%）]
治疗组 12 58 ± 11 4/8 24 ± 4 4（33.33） 6（50.00） 5（41.67）
对照组 19 60 ± 14 5/14 23 ± 4 8（42.10） 6（31.58） 6（31.58）
t/χ2值 ? 0.468 0.170 0.943 0.012 0.419 0.035
P值 ? 0.643 0.680 0.354 0.913 0.518 0.852
组别 例数 APACHEⅡ评分（分） SOFA评分（分） 降钙素原（μg/L） 心血管危险因素（个） ICU住院时间（d） 与感染相关[例（%）]
治疗组 12 18 ± 4 7.4 ± 2.3 3.4 ± 1.3 3.3 ± 1.1 16 ± 5 4（33.33）
对照组 19 16 ± 4 8.2 ± 2.5 3.8 ± 1.5 3.7 ± 1.2 21 ± 6 5（26.32）
t/χ2值 ? 2.057 0.894 0.760 0.933 2.110 0.170
P值 ? 0.049 0.379 0.453 0.359 0.044 0.680
表2 两组TTC患者心脏相关指标的比较（ ± s）
组别 例数 LVEF（%） LVDD（mm） cTnI（μg/L） 脑钠肽前体（ng/L）
入院时 出院时 入院时 出院时 入院时 高峰值 入院时 高峰值
治疗组 12 36 ± 6 59 ± 9 52 ± 8 49 ± 5 3.1 ± 1.1 8.7 ± 3.2 1 832 ± 612 1 625 ± 578
对照组 19 37 ± 6 52 ± 8 53 ± 7 47 ± 5 3.5 ± 1.3 11.4 ± 3.6 1 625 ± 578 4 753 ± 965
t值 ? 0.501 2.062 0.608 0.796 0.883 2.120 0.950 2.989
P值 ? 0.620 0.048 0.548 0.433 0.384 0.043 0.350 0.006
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