Effects Of Levosimendan On The Cardiac Function And Prognosis In Elderly Patients With Septic Myocardial Contractility Impairment

ObjectiveTo investigate the effects of levosimendan on the cardiac function and prognosis in elderly patients with septic myocardial contractility impairment.MethodsA prospective,randomized,controlled study was conducted.The elderly patients with septic myocardial contractility impairment admitted to Intensive Care Unit in Zhejiang Hospital from January 2017 to September 2017 were consecutively enrolled.Elderly septic shock patients with left ventricular ejection fraction(LVEF)≤50% after fluid resuscitation were enrolled the study.The trial recruited 30 patients,which were randomly assigned to divided into the levosimendan group(n=15)and the dobutamine group(n=15).After the conventional treatment,the patients in dobutamine group received intravenous injection of dobutamine(at a dose of 5 μg per kilogram of body weight per minute)for 24 hours,and those in levosimendan group received a 24 hours infusion of levosimendan(at a dose of 0.2μg per kilogram of body weight per minute).At time of ejection start(0h)and 24 hours,48 hours,72 hours after ejection start,we recorded blood pressure,heart rate(HR)and lactic acid(Lac),liver and kidney function,cardiac troponin I(c Tn I),NT-pro BNP and echocardiographic parameters including left ventricular ejection fraction(LVEF),cardiac output(CO),stroke volume(SV),Early rapid filling of left ventricular diastolic filling peak(E)/ Late filling of left ventricular diastolic filling peak(A),left ventricular end-diastolic diameter(LVIDd),left ventricular end-systolic diameter(LVIDs),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),tricuspid annular plane systolic excusion(TAPSE)and acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ).The time of mechanical ventilation,length of stay in ICU and 28-day mortality were compared with two groups.ResultsCompared with the dobutamine group,the level of blood lactic acid at time of 24 hours[(1.97±1.10)mmol/L vs.(2.73±2.06)mmol/L,P=0.002] decreased obviously in the levosimendan group.the level of LVEF and SV were signicantly higher at time of 24 hours[LVEF:(47.93±5.01)% vs.(45.60±5.47)%,P=0.004;SV:(47.73±14.01)ml vs.(44.80±16.89)ml,P=0.035;respectively],48 hours [LVEF:(51.07±5.05)%% vs.(46.73±6.34)%,P=0.004;(49.87±14.15)ml vs.SV:(45.07±16.94)ml,P=0.005;respectively] and 72 hours[LVEF:(53.20±5.92)% vs.(47.70±6.71)%,P=0.002;SV:(51.27±14.98)ml vs.(45.73±17.34)ml,P=0.010].the time of mechanical ventilation,length of stay in ICU and 28-day mortality between the two groups.ConclusionLevosimendan could improve the cardiac systolic function and the tissue perfusion in elderly patients with septic myocardial contractility impairment.However,it could not improve cardiac diastolic function and kidney function.There was no significant decreases in the time of mechanical ventilation,length of stay in ICU and 28-day mortality.