作者单位：510080 广州，中山大学附属第一医院心脏外科ICU

左西孟旦在心脏术后心肾综合征患者中的应用

张宝冯康倪王翠苹杨嵩张文波李华明唐白云

【摘要】目的探讨左西孟旦在心脏术后心肾综合征(CRS)患者中的临床疗效，寻找由心功能不全导致肾功能不全的新治疗方法。方法统计143例心脏术后早期心肾综合征患者，其中A组68例未使用左西孟旦，B组75例患者术后早期使用左西孟旦，对比2组术后第1、2、3日血管活性正性肌力药物评分(VIS), 脑钠肽前体(proBNP)、肾小球滤过率(eGFR)、尿量、主动脉球囊反搏(IABP)和持续肾替代治疗(CRRT)使用情况及ICU停留时间。结果2组在术前心功能、手术体循时间无明显差异(P>0.05)，术后第1日B组VIS即小于A组且有差异(P<0.05)；第2日B组proBNP浓度小于A组 (P<0.05)；第3日B组eGFR及尿量均高于A组(P<0.05)；CRRT使用患者比例B组小于A组(P<0.05)，IABP使用率无差异。结论左西孟旦在心脏术后心肾综合征患者中的应用可减少儿茶酚胺类药物的使用量，改善心功能，增加尿量，有助于肾功能恢复。

【关键词】左西孟旦；心脏手术；心肾综合征

DOI:10.3969/g.issn.0253-9802.2015.07.010

通讯作者，唐白云，E-mail: tangbaiyun611@163.com

Abstract【】ObjectiveTo investigate the clinical effect of levosimendan (LEVO) in patients with cardiorenal syndrome (CRS) after cardiac surgery and uncover new methods for the treatment of renal insufficiency induced by cardiac insufficiency. Methods In total, 143 patients who exhibited early CRS after cardiac surgery were included. The patients were divided into two groups: group A (n=68, without LEVO treatment) and group B (n=75, with LEVO treatment). The two groups were compared in terms of vasoactive-inotropic scores (VIS), pro-brain natriuretic peptide (proBNP) levels, estimated glomerular filtration rates (eGFR), urine output, usage of an intra-aortic balloon pump (IABP), usage of continuous renal replacement therapy (CRRT), and ICU monitoring time on postoperative days (POD) 1, 2, and 3. ResultsNo significant difference between the two groups of patients was observed with respect to preoperative cardiac function or cardiopulmonary bypass time (P>0.05). The VIS in group B were significantly lower than those in group A on POD 1 (P<0.05); the proBNP levels in group B were lower than those in group A on POD 2 (P<0.05); and the eGFR and urine output in group B were significantly higher than those in group A on POD 3 (P<0.05). Group B showed less use of CRRT than group A (P<0.05), while no difference in the usage of an IABP was observed. ConclusionsLEVO reduces the catecholamine dosage, improves cardiac function, and increases urine output, thus contributing to the recovery of renal function in patients with CRS after cardiac surgery.

收稿日期：(2015-01-30)

Application of levosimendan in patients with cardiorenal syndrome after cardiac surgeryZhangBao,FengKangni,WangCuiping,YangSong,ZhangWenbo,LiHuaming,TangBaiyun.DepartmentofCardiacSurgeryICU,theFirstAffiliatedHospitalofSunYat-senUniversity,Guangzhou510080,China

Correspondingauthor，TangBaiyun,E-mail:tangbaiyun611@163.com

【Key words】Levosimendan; Cardiac surgery; Cardiorenal syndrome

心肾综合征(CRS)是心、肾2个器官，由于一个存在功能不全导致另一个器官功能不全，当两者同时存在时显著降低预后的临床病症。目前分为5型，心脏外科最常见的是Ⅰ型和Ⅱ型，即急、慢CRS。目前治疗方法有利尿药、ACEI、血液透析等，治疗手段有限，且有一定争议。左西孟旦是新型正性肌力药，已在欧美30多个国家广泛使用，临床效果确切，2012年ESC指南将左西孟旦作为急性心力衰竭推荐使用药物，但对于CRS患者的应用尚无明确报道[1]。本文收集我科从2011年1月至2014年10月CRS患者143例，其中75例使用左西孟旦(68例患者因早期左西孟旦尚未引进未使用该药)，现将对比结果报告如下。

对象与方法

一、 研究对象

选择中山大学附属……