The application opportunity of levosimendan during open heart surgery in postoperative severe patients

doi:10.3969/j.issn.1002-7386.2014.23.007

Abstract：Objective To investigate the therapeutic effect of levosimendan in different time points on severe patients after open heart surgery.Methods Ninety-two severe patients who were treated with levosimendan after open heart surgery from November 2012 to August 2014 were enrolled in the study.According to the application time of levosimendan,the patients were divided into two group,group A ( n =42):levosimendan was applied immediately after the patients came back intensive care unit ( ICU) , group B ( n =50 ): levosimendan was administrated after the kinds and dose of vasoactive drugs were increased.After open heart surgery, the application condition of vasoactive drugs, changes of proBNP, LVEF, mechanical ventilation time,ICU monitoring time and hospitalizing time,the condition of using mechanical heart assist device,patients’ complications and mortality were observed and compared between the two groups.Results The application dose of vasoactive drugs after operation in group A was significantly lower than that in group B,and application time was shorter than that in group B.After application of levosimendan,LVEF was obviously increased,as compared with that before application for both groups, however,proBNP was obviously decreased.Before application of levosimendan,LVEF in group A was significantly lower than that in group B ( P <0.05),however,at 24h,3d,7d after application of levosimendan,LVEF in group A was significantly higher than that in group B.Before application of levosimendan,proBNP in group B was higher than that in group A,after application of levosimendan, proBNP in different time points was decreased in both groups, but there was no significant difference ( P >0.05).The mechanical ventilation time, ICU monitoring time and hospitalizing time in group A were significantly shorter than those in group B,however,the incidence of complications after operation in group B was significantly higher than that in group A ( P <0.05).The incidences of using mechanical heart assist device (IABP,ECMO) and mortality in group B were higher than those in group A,however,there were no significant differences between two groups ( P >0.05) . Conclusion The application of levosimendan immediately after open heart surgery can reduce the usage dose of vasoactive drugs and usage time,improve cardiac function more quickly,decrease the incidence of low cardiac output syndrome and acute renal failure,reduce hospitalizing time,moreover,reduce possibly the mortality and usage of subsequent mechanical heart assist device.