The impact of levosimendan combined with milrinone on vascular and cardiac and renal function in postoperative low cardiac output syndrome patients

ZHAO Jianliang; HUANG Tao

doi:10.3969/j.issn.1672-8157.2025.08.011

Abstract：Objective To explore the effects of levosimendan combined with milrinone on vasoactive activity,car-diac and renal function in patients with low cardiac output syndrome(LCOS)after cardiac surgery.Methods A total of 76 LCOS patients who underwent cardiac surgery at the 3201 Hospital from April 2022 to December 2024 were retrospectively selected and divided into the control group and the observation group based on their treatment regimens. The control group received conventional therapy combined with milrinone(n=38),and the observation group received levosimendan in addition to the control group's treatment(n=38).Both groups received maintenance therapy for 48 hours.The levels of vasoactive indi-cators(cardiac index(CI),vasoactive-inotropic score(VIS)),hemodynamic indicators(heart rate(HR),systolic blood pressure(SBP),mean arterial pressure(MAP)),myocardial injury markers(cardiac troponin I(cTnI),N-terminal pro-B-type natriuretic peptide(NT-proBNP),blood lactate(Lac)),renal function indicators(serum creatinine(Scr),cystatin C(CysC),glomerular fil-tration rate(GFR))before and after treatment,and the incidence of adverse reactions were compared between the two groups.Results After treatment,the CI level of patients in the control group and the observation group increased,and the VIS score de-creased.Moreover,the CI level in the observation group((2.88±0.09)L/(min·m2))was higher than that in the control group((2.74±0.13)L/(min·m2)),and the difference was statistically significant(t=5.458,P<0.05).The VIS score in the observation group((16.24±2.93)points)was lower than that in the control group((18.79±3.15)points),and the difference was statistically significant(t=3.654,P<0.05).After treatment,the HR levels of patients in the control group and the observation group decreased,while the SBP and MAP levels increased.Moreover,the HR level in the observation group((78.54±5.62)beats/min)was lower than that in the control group((83.15±5.74)beats/min),and the difference was statistically significant(t=3.51,P<0.05).The levels of SBP and MAP in the observation group((96.41±5.64)mmHg(1 mmHg=0.133 kPa)and(75.76±3.34)mmHg,respectively)were higher than those in the control group((90.27±4.98)mmHg and(71.76±5.49)mmHg,respectively),and the differences were statistically significant(t=5.031,3.837,both P<0.05).After the treatment,the levels of cTnI,NT-proBNP and Lac in the control group and the observation group decreased.Moreover,the levels in the observation group((386.84±89.47)ng/L,(1 734.62±401.13)ng/L,(0.81±0.26)mmol/L,respectively)were lower than those in the control group((471.71±84.61)ng/L,(2 106.34±376.12)ng/L,(1.04±0.31)mmol/L,respectively),and the differences were statistically significant(t=4.249,4.172,3.504,all P<0.05).After treatment,the levels of Scr and CysC in the control group and the observation group decreased,while the level of GFR increased,and the levels of Scr and CysC in the observation group((2.38±0.68)mg/L and(0.64±0.18)mg/L,respectively)were lower than those in the control group((3.34±0.82)mg/L and(0.92±0.25)mg/L,respectively).The GFR level in the observation group((123.73±4.71)mL/(min·1.73 m2))was higher than that in the control group((116.72±7.69)mL/(min·1.73 m2)).The differences were statis-tically significant(t=5.555,5.603,5.814,all P<0.05).The incidence of adverse reactions in the observation group was 7.89%(3/38),while that in the control group was 10.53%(4/38),with no statistically significant difference(χ2=0.001,P>0.05).Conclusion The combination of levosimendan and milrinone in the treatment of LCOS after cardiac surgery demonstrates significant efficacy,en-hances myocardial contractility,reduces peripheral vascular resistance,protects renal function,and exhibit good safety.