The Application Of Levosimedan In Patients With Cardiogenic Shock Complicated By Acute Myocardial Infarction Monitered By Pulse Indicate Contour Cardiac Output (PICCO)

Background And Purpose:With the rapid development of economy in our country and the sustained improvement of people’s living standard,the incidence of cardiovascular disease is increasing year by year and more and more younger.AMI has became one of the cardiac disease with highest mortality and mrobidaty.However,cardiogenic shock (Cardiogenic shock, CS) is a serious complication of acute myocardial infarction.After acute myocardial infarction,the ventricular contractility is decreased,while the myocardial stiffness is increased.The ventricular diastolic function which is influenced by myocardial cells’ edema complicated with AMI leads to cardiogenic shock. Moreover, ventricular remodeling, arrhythmias and the mechanical complications of myocardial infarction can contribute to the occurrence of cardiogenic shock. The patients with cardigenic shock complicated by AMI will have a poor prognosis if they do not have a timely and effective treatment.The patients with acute myocardial infarction has sympathetic activation, myocardial ischemia and the possible of cardiac rupture and other mechanical complications. It makes the appliction of traditional inotropic agents were limited.Because the side effect of traditional inotropic agents can induced these complacations. Recently, many animal experiments confirmed that the application of levosimendan which is a new calcium sensitizer as a inotropic agents to acute myocardial infarction has no effect on myocardial oxygen consumption and heart rate while the scope of myocardial infaction is reduced.However,the hemodynamic of patients with cardiogenic shock is influenced by the vasodilator effect of levosimedan.Because of the impact.it is apparent that the monitor of hemodynamic of the patients with cardiogenic shock complicated by acute myocardial infartion is particularly necessary.Swan-Ganz catheter is recognized as the gold standard of hemodynamic monitoring.With the innovation of the technology,PICCO monitor system as a new method on hemodynamic monitoring is more and more popular.PICCO monitor system can not only continuous monitor the cardiac output(CO) but also the other hemodynamic parameters,such as global endless diastolic volume(GEDV)、systemic venous resistance (SVRI)、eatra-vascular lung water(eatra-vascular lung water,EVLW).Compared with the Swan-Ganz catheter,PICCO monitor system can monitor the hemodynamic of patients more comprehensively and effectively.Method:A total of 40 patients with cardigenic shock complicated by acute myocardial infarction were enrolled from January 2014 to December 2015 in Chinese PLA general hospital.They were randomly devided into levosimedan group(n=20) and control group(n=20) according to a computer-generated randomization schedule. All culpritvessels revascularization were conducted in Cardiac Intervention Center by emergency percutaneous coronary intervention(PCI).All patients were applied by IABP support and the Dopamine.They were treated in a Cardiac Care Unit.The patients were established standard therapy including anticoagulant, antiplatelet, nutrition,statins and other drugs while their blood pressure were monitored.Levosimedan was administered in levosimedan group with a loading dose of 12 ug/kg over 10min,followed by 0.1ug/kg/min for 1h,and of 0.2ug/kg/min infused over the left time for total of 24h. Dextrose Injection was administered in control group with the same infusion rate with levosimedan group. To combine other inotropic agents if increasing the dose of Dopamine can not stabilize blood pressure when the blood pressure decresed in the treatment.PICCO monitor system was applied to monitor the hemodynamic at the time of before treatment,after 3h,6h,12h,1d,3d,7d.Each point detection time to take 15ml ice brine continuous thermodilution cardiac output measured three times and averaged. IABP was paused before monitor for lmin. The endpoint of event was death within a month.Results:1.The comparsion of clinical data:Compared with the two groups before treatment, there were no statistical significance (P>0.05)about sex, age, body mass index, heart rate, blood pressure and diabetes hypertension, hyperlipidemia, smoking history, history of myocardial infarction, history of cerebrovascular disease, peripheral vascular disease history.2. The comparison of biochemical results:After treatment,compared with control group,there are no statistical significance about electrolytes (potassium, sodium, chloride, calcium), lipids, blood glucose;BNP of levosimedan group are decreased compared with control group, There were significant differences (P<0.05)3. The comparison of PICCO parameters:Compared with before treatment,the parameters of hemodynamic monitered by PICCO are significant difference; compared with two groups,cardiac index(CI), there are significant difference of cardiac fraction idex(CFI),stroke volume index(SVI), global ejection fraction(GEF) and systemic venous resistance (SVRI) (P<0.05);and there are no difference of extra-vascular lung water index(ELWI),global endless diastolic index(GEDI) and intrathoracic blood volume index(ITBI).4. The comparison of treatment:Before treatment,there are no difference of the basline status between the two groups;during the treatment,control group has more patients who use more than one type of inotropic agents than levosimedan group(P<0.05);after treatment,the duration of IABP counterpulsation and the length of days in cardiac care unit of control group are longer than the levosimedan group(P<0.05).5. The comparison of prognosis:The people of death within 1 month between two groups has no statistical difference,but the people of death complicated by multiple organ failure of levosimedan group is statistically lower than the control group(P<0.05).6.The safety of levosimedan:There is little increase of Alanine aminotransferase(ALT),Aspartate transaminase(AST),Creatinine(Cr) during the treatment compared with before treatment in levosimedan group(P>0.05);at the 7th day after treatment,the level of AST,ALT,and Cr declined,and has no statistical difference(P>0.05).Conclusions:1.PICCO can moniter the hemodynamic of patients accurately, timely, and effectively.2.Levosimendan can rapidly improve the hemodynamics,significantly decline the BNP levels,improve the cardiac function of the patients with cardiogenic shock complicated by acute myocardial infarction.3.Levosimedan can decrease the time of IABP counterpulsation and the length of days in cardiac care unit of the patients with cardiogenic shock complicated by acute myocardial infarction.4.Lvesimedan can decrease the death caused with muitiple organ failure of the patients with cardiogenic shock complicated by acute myocardial infarction.5. of levosimedan It can sustain 5-7days about the inotropic effect and 1-3 days about vasodilation of levosimedan.6.The reversible injury of liver and kidney function may be caused by levosimedan.It also can induce a slight decrease in blood pressure,but its use in patients with cardiogenic complicated by acute myocardial infarction is safety.