| Objective: With the development and progress of society, population aging, trauma, increased environmental pollution increase, there are some drugs misuse of antibiotics and hormones, making the incidence of sepsis increased year by year. Severe trauma, shock, infection, major surgery can lead to sepsis occurred, part of the development of severe sepsis, septic shock, multiple organ dysfunction syndrome and even become one of the main causes of death in critically ill patients with severe. Most of the dead because of persistent refractory hypotension and cardiovascular collapse. Levosimendan is a novel calcium sensitizer, there are many animal studies found that levosimendan improves sepsis-induced myocardial depression. The purpose of this study was to observe the levosimendan for severe sepsis and septic shock, myocardial depression in patients with cardiac function.Methods: Before the study was approved by the Medical Ethics Committee of the Bethune International Peace Hospital, Informed consent by the patient’s family, from December 2013 to December 2014, screening visit within the ICU, patients admitted to hospital after being diagnosed with or at check in accordance with clinical, radiological or laboratory diagnosis of severe sepsis and septic shock in 125 cases in the Bethune International Peace Hospital, after which the fluid resuscitation, cardiac function was assessed using echocardiography, left ventricular ejection fraction(LVEF) ≤45% of the 27 cases met the inclusion criteria included in the results of the analysis of this prospective observational study, included in the results of this prospective observational study analysis, and randomly divided into two groups, among the control group(dobutamine group) 13 cases, the experimental group(levosimendan group) 14 cases. In conventional therapy, after fluid resuscitation, dobutamine group that continuous intravenous infusion of dobutamine 10μg/kg/min 72 hours; Levosimendan group of patients in the continuous intravenous infusion of dobutamine 10μg/kg/min 72 hours, based on the first 24 hours a continuous intravenous infusion of levosimendan 0.2μg/kg/min. Two groups of patients were enrolled at the time the determination of left ventricular ejection fraction(LVEF), serum troponin I(c Tn I), B-type natriuretic peptide precursor(NT-pro BNP), procalcitonin(PCT), APACHE II score is calculated,2012 on the basis of the basic treatment of severe sepsis and septic shock therapy international guidelines( rehydration, antibiotics, mechanical ventilation, use of vasoactive drugs, etc.), 24 hours after treatment, 72 hours again left ventricular ejection fraction were measured in serum troponin I(c Tn I), B-type natriuretic peptide precursor(NT-pro BNP), procalcitonin(PCT), APACHE II score is calculated. Observed in patients admitted to the ICU for several days, all-cause mortality in the ICU. Data using SPSS(16) statistical analysis software, compare the measurement data between groups using t test, count data were compared using chi square test, P<0.05 for the difference between groups was statistically significant.Results: Two groups of patients were enrolled at the time of left ventricular ejection fraction(LVEF) was no significant difference(P>0.05), levosimendan group 24 hours after treatment, 72 hours left ventricular ejection fraction(LVEF) was significantly higher when compared with the group, there was a significant difference(P<0.05), dobutamine group 24 hours after treatment, 72 hours left ventricular ejection fraction(LVEF) was increased, there was a significant difference in 24 hours after treatment(P<0.05), 72 hours there was no significant difference(P>0.05). Two groups of patients were enrolled at the time of the APACHE II score, serum troponin I(c Tn I), B-type natriuretic peptide precursor(NT-pro BNP), procalcitonin(PCT) were not significantly different(P>0.05), 24 hours after the levosimendan group therapy, 72 hours APACHE II score, serum troponin I(c Tn I), B-type natriuretic peptide precursor(NT-pro BNP) has declined, 72 hours levosimendan group decreased significantly, there was a significant difference(P<0.05). Dobutamine group 24 hours after treatment, and 72 hours after treatment, APACHE II score, serum troponin I(c Tn I), B-type natriuretic peptide precursor(NT-pro BNP) were not significantly different(P>0.05); Two sets of procalcitonin(PCT) 24 hours after treatment, 72 hours relatively decreased, but there was no significant difference(P>0.05). The number of days in ICU levosimendan group and dobutamine group(7.35±2.61 d vs 8.84±4.50d), all-cause mortality in the ICU(21.43% vs 23.07%) showed no significant difference(P>0.05).Conclusion: Levosimendan therapy can improve severe sepsis and septic shock, myocardial depression in patients with cardiac function. |
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