Effects of levosimendan on systemic and regional hemodynamics in septic myocardial depression
Effects of levosimendan on systemic and regional hemodynamics in septic myocardial depression
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DOI：
10.1007/s00134-005-2619-z
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发表时间：
2005-05-01
影响因子：
38.9
通讯作者：
Pietropaoli, P
中科院分区：
文献类型：
--
作者：
Morelli, A;De Castro, S;Pietropaoli, P
目的：钙脱敏在脓毒性心肌抑制的病理生理中起重要作用。我们假设左西孟旦，一种新的钙增敏剂，将有利于败血症引起的心功能障碍。设计和背景：在两所大学附属医院重症监护室进行的前瞻性、随机、对照研究。患者和参与者：28例在接受包括多巴酚丁胺（5 μ g/kg /分钟）在内的常规治疗48小时后，与感染性休克相关的持续性左心室功能障碍患者。干预措施：在常规治疗48小时后，患者随机接受左西孟旦（0.2 μ g/kg /分钟，n=15）或多巴酚丁胺（5 μ g/kg /分钟，n=13） 24小时输注。测量和结果：取药物输注前后24小时右心导管、超声心动图、胃张力计、激光多普勒血流仪、乳酸浓度和肌酐清除率数据。多巴酚丁胺不改变全身或局部血流动力学变量。相比之下，在相同的平均动脉压下，左西孟旦降低肺动脉闭塞压，增加心脏指数。左西孟旦降低左室舒张末期容积，增加左室射血分数。左西孟旦增加胃粘膜流量、肌酐清除率和尿量，同时降低乳酸浓度。结论：这些发现表明，在每分钟给予5 μ g/kg多巴酚丁胺不再有效的情况下，左西孟旦可改善脓毒性心功能障碍患者的全身血流动力学和局部灌注。因此，我们的研究结果表明，在这种情况下，左西孟旦可以作为增加多巴酚丁胺剂量的替代策略。
Objective: Calcium desensitization plays an important part in the pathophysiology of septic myocardial depression. We postulated that levosimendan, a new calcium sensitizer, would be beneficial in sepsis-induced cardiac dysfunction. Design and setting: Prospective, randomized, controlled study in two university hospital intensive care units Patients and participants: Twenty-eight patients with persisting left ventricular dysfunction related to septic shock after 48 h of conventional treatment including dobutamine (5 mu g/kg per minute). Interventions: After 48 h of conventional treatment patients were randomized to receive a 24-h infusion of either levosimendan (0.2 mu g/kg per minute, n=15) or dobutamine (5 mu g/kg per minute, n=13). Measurements and results: Data from right heart catheterization, echocardiography, gastric tonometry, laser-Doppler flowmetry, and lactate concentrations and creatinine clearance were obtained before and after the 24-h drug infusion. Dobutamine did not change systemic or regional hemodynamic variables. By contrast, at the same mean arterial pressure levosimendan decreased pulmonary artery occlusion pressure and increased cardiac index. Levosimendan decreased left ventricular end-diastolic volume and increased left ventricular ejection fraction. Levosimendan increased gastric mucosal flow, creatinine clearance, and urinary output while it decreased lactate concentrations. Conclusions: These findings show that levosimendan improves systemic hemodynamics and regional perfusion in patients with septic cardiac dysfunction under conditions where administration of 5 mu g/kg dobutamine per minute is no longer efficacious. Accordingly, our results suggest that levosimendan can be an alternative to the strategy of increasing the dose of dobutamine under such conditions.