The Impact Of Intravenous Levosimendan On Septic Shock Patients With Myocardial Suppression

OBJECTIVE:Septic shock is one of the main causes of the death in critically patients.Patients has some characteristics like hypotension myocardial suppression and so on.Myocardial suppressions the most serious complications.With the development of society and the increasing trend of population aging,the incidence of sepsis also showed an upward trend year by year.At present,the main clinical treatment of septic shock is circulating support and anti-infection.Actually it has not been significantly improved the mortality.Levosimendan is a new type of inotropic drugs,used to cardiac surgery and acute heart failures.Some animal experiments also believe that levosimendan for sepsis-induced myocardial suppression treatment can be effective.However,the clinical efficacy of levosimendan in patients with septic shock remains unclear.In this study,prospective randomized controlled trials were used to investigate the effects of levosimendan on myocardial suppression in patients with septic shock.Methods:According to the diagnostic criteria,94 patients with septic shock admitted in our hospital from March 2014 to June 2015 were divided into the control group(dobutamine treatment)according to the method of complete random number table.The observation group(levosimendan treatment)of 47 cases.In the control group,continuous intravenous infusion of dobutamine was given for 72 hours.The basal pumped rate was 10μg/kg/min,and the dosage of levosimendan was given to the control group.The rate of intravenous infusion was maintained at 0.2μg/kg/min,and the rate was adjusted according to the patient’s actual condition.Before contrast APACHE II score,lactose(Lac),brain natriuretic peptide(BNP),troponin(cTnI),cardiac output index(CI);while in the treatment of 3d,6d after comparing the two groups of brain natriuretic peptide(BNP),cardiac troponin(cTnI),stroke volume index(SVI),cardiac output index(CI),lactose(Lac),heart rate(HR),blood pressure(MAP),the amount of norepinephrine(NE dosage),left ventricular ejection fraction(LVEF),and the statistical mechanical ventilation time two groups of patients,ICU length of stay in the ICU and all-cause mortality.RESULTS①The comparative analysis of two groups of patients before treatment,BNP,cTnI,CI,APACHE II and Lac,there are no significant differences between the two(P>0.05);②hemodynamic comparative results after treatment 3d,CI observation group was(3.41± 0.67)L/min/m2,significantly higher than the control group level;the observation group,the levels of BNP,Lac and cTnI levels were(287.58 ± 45.39)ng/L,(3.17 ± 1.35)mmol/L,(2.18 ± 0.95)ng/L,significantly lower than the control group,the difference was significant(t=2.88,8.90,2.46,2.58;P<0.05).No significant difference in SVI comparison between the two groups(t=0.54,P>0.05);③after treatment 6d,CI and SVI levels were(4.76 ± 1.97)L/min/m2,(37.62 ± 3.10)mL/m2,significantly higher than that of the control group,the observation group BNP,Lac and cTnI level in the level for(210.85 ± 24.57)ng/L,(2.76 ± 1.80)mmol/L,(1.37 ± 0.54)ng/L,significantly lower than the control group,the difference was significant(t=2.88,4.02,10.95,10.85,4.21;P<0.05);④observation group:heart rate,the amount of NE in the observation group were(91.20 ± 22.57)times/min,(0.35 ±0.08)g/(kg.min)was significantly lower than the control group and the observation group,MAP and LVEF were(84.33 ± 4.50)mmHg,(53.08 ± 4.02)%,compared with the control group improved significantly,the differences between the two groups was significant(t=3.21,16.36;P<0.05);⑤the observation group of ICU mechanical ventilation time,hospitalization time,APACHE II were(5.0±2.0)d,(8.5 ±2.0)d,(13.79 ± 3.57),were significantly shorter than the control group,with statistically significant difference between groups(t=20.04,3.30,18.43;P<0.05);the observation group.⑥ICU all-cause mortality was 13 cases(27.7%),and 19 cases in the control group(40.4%)comparison,comparison between groups showed no significant difference(X2 = 5.52,P>0.05).Conclusion:Levosimendan is effective in the treatment of septic shock in patients with acute myocardial infarction.It is helpful to improve cardiac systolic function,shorten mechanical ventilation time and ICU hospitalization time.BNP,cTnI and other factors have decreased significantly.