The clinical efficacy of levosimendan in the treatment of patients with acute myocardial infarction combined with cardiogenic shock and its effects on monitoring hemodynamic parameters of pulse index continuous cardiac output / 中国医师进修杂志

ABSTRACT

Objective:To observe the clinical efficacy of levosimendan in the treatment of patients with acute myocardial infarction (AMI) combined with cardiogenic shock (CS) and its effects on monitoring hemodynamic parameters of pulse index continuous cardiac output (PICCO).Methods:One hundred and six patients with AMI combined with CS admitted and treated in Jiaxing Second Hospital from June 2017 to December 2019 were divided into the control group and observation group according to the random number table method , with 53 cases in each group. The control group received routine comprehensive intervention, while the observation group received levosimendan treatment based on the control group. In observation group, 12 μg/kg of levosimendan was administered intravenously within 10 min, then, 0.1 μg/(kg·min) was administered intravenously and continued for 24 h. In control group, 5% glucose injection was administered intravenously, and the intravenous infusion rate and time was same as that in observation group. Both groups were treated for 24 h. PICCO was used to monitor the hemodynamic parameters , including heart rate (HR), central venous pressure (CVP), cardiac index (CI), global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) before and after the treatment; the neurohumoral indexes including norepinephrine (NE), angiotensinⅡ(AngⅡ); cardiac function indexes including stroke volume (SV), left ventricular ejection fraction (LVEF), and the efficacy and complications were observed and compared between two groups.Results:After 24 h of treatment, the levels of HR, CVP, GEDVI, EVLWI in two groups were decreased, and the levels of above index in the observation group were lower than those in the control group (90.26 ± 12.61) beats/min vs. (97.82 ± 12.58) beats/min, (9.85 ± 1.14) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (11.63 ± 1.37) cmH 2O, (759.53 ± 62.47) ml/m 2 vs. (867.21 ± 63.24) ml/m 2, (7.95 ± 1.56) ml/kg vs. (9.01 ± 1.78) ml/kg; after treatment the level of CI in the observation group was higher than that in the control group (3.58 ± 0.74) L/(min·m 2) vs. (2.37 ± 0.86) L/(min·m 2), and the differences were statistically significant ( P<0.05). After 24 h of treatment, the levels of NE and AngⅡ in two groups was decreased, and the levels of NE and AngⅡ in the observation were lower than those in the control group (60.42 ± 5.93) ml vs. (54.42 ± 6.14) ml, (41.62 ± 4.19)% vs. (36.87 ± 4.36)%, and the differences were statistically significant ( P<0.05). After 24 h of treatment, the time of intra-aortic balloon counterpulsation (IABP) in the observation was shorter than that in the control group (61.52 ± 15.41) h vs. (89.56 ± 17.63) h; the injury rate of renal functions in the observation was lower than that in the control group 3.77%(2/53) vs. 18.87%(10/53), and the differences were statistically significant ( P<0.05). There was no significant difference in mortality and other complications after 30 d of follow-up between two groups ( P>0.05). Conclusions:Levosimengdan can significantly improve the PICCO hemodynamics, neurohumoral indexes and cardiac function indexes of patients with AMI and CS. It has a protective effect on the kidneys of patients, but it cannot significantly improve the 30-day mortality rate of patients.