Effects Of Levosimendan On Cardiac Function After Mitral Valve Replacement

Objective:With the socio-economic development and aging population,the incidence of valvular heart disease increase significantly,and early patients with valvular heart disease are often overlooked because symptoms are not obvious.With the continuous progress of heart valve disease,severe heart valve disease has gradually become one of the main causes of death in elderly patients.For some serious mitral valve disease,surgical treatment is the most effective way to improve cardiac function in patients with mitral valve,namely mitral valve replacement.The early mortality rate after mitral valve replacement is high,so cardiac drugs are often used to improve the prognosis.Traditional cardiac drugs can improve early hemodynamics in patients,but may cause myocardial ischemia,arrhythmia,and may associate with high mortality after surgery.There is an urgent need for a dual mode of action that achieves a goal that does not affect heart rate and does not significantly increase myocardial oxygen consumption.Levosimendan increased cardiac output,as well as coronary and renal blood flow.It also reduces the preload and postload,and can restore the Stunning of myocardium.Foreign studies have shown that levosimendan has important hemodynamic significance for postoperative recovery in patients with severe mitral valve replacement.However,there are few studies on levosimendan in cardiac surgery,especially after mitral valve replacement.In this study,we analyzed the effect of levosimendan on mitral valve replacement by statistical,analysis and contrast,and discussed the effect of levosimendan on cardiac function after mitral valve replacement,so as to provide a reliable clinical experimental basis,new ideas and directions For the treatment after the mitral valve replacement.Methods:In this study,we selected patients who underwent mitral valve replacement from the Department of Cardiac Surgery at the Second Hospital of Hebei Medical University from October 2015 to August 2016.All the patients were randomly divided into levosimendan group and non-levosimendan group by random envelope method,32 cases in each group,totally 64 cases.We put severe after the replacement of heart valve disease patients into two groups,one group of levosimendan,a set of no use.The trial group used levosimendan after mitral valve replacement,while the control group used conventional cardiac drugs after mitral valve replacement without the use of levosimendan.Two groups of patients after surgery adopts the traditional strong heart,diuresis medicine,ACEI,nitrates,angiotensin II receptor antagonist drugs,beta blockers and other drugs.Used immediately after mitral valvereplacement,micro pump pumping levosimendan injections for 24 hours?0.5mg/h?.We compared two groups of postoperative urinary volume,LVEF and SV of rise and decline of left ventricular diameter,central venous pressure,blood oxygen saturation,length of hospital stay,postoperative dyspnea and cardiac functional grading,comprehensive evaluation of drug efficacy and safety.The data were analyzed and summarized by SPSS13.0 statistical software,and the difference was statistically significant when P<0.05,find out and summarize the relationship between the data.The statistical data of the relevant data were analyzed and discussed for reliable clinical experimental basis.Results:1 The average daily urine output of the test group was 178.28±14.54ml,and the average daily urine output of the control group was 166.72±21.77ml,t=2.523,P=0.014<0.05,so the urine volume per hour was statistically significant.2 Compared with the control group,the mean value of LVEF was significantly higher in the test group?62.03%vs 60.81%,t=2.419,P=0.019?.There were significant differences in SV mean between the experimental group and the control group?68.32ml vs 65.66ml,t=2.065,P=0.043?,the difference between the two groups was significant.The difference of LVD between the experimental group and the control group was statistically significant?48.09mm vs 51.15mm,t=2.072,P=0.042<0.05?.3 The mean central venous pressure in the test group was 8.941±1.69Kpa,and the mean central venous pressure in the control group was 10.027±2.32Kpa?t=2.054,P=0.044?,so the central venous pressure of the two groups was significantly different.4 The average oxygen saturation of the test group was 98.44±1.68%,while the average oxygen saturation in the control group was 96.91±2.12%?t=3.204,P=0.002<0.05?,so the oxygen saturation was significantly different between the two groups.5 The average hospital stay was 10.06±2.384 days in the experimental group and 11.54±3.335 days in the control group.t=2.063,P=0.043<0.05.There was a significant difference between the test group and the control group at the time of hospitalization.6 There were 96.9%of the patients with dyspnea symptoms improved in the test group and 81.3%in the control group.x₂=4.010,P=0.045<0.05.Dyspnea symptoms improved significantly compared between the two groups.93.8%of the patients in the test group had improved cardiac function grade and 75.0%in the control group.x₂=4.267,P=0.039<0.05.The improvement of cardiac function was significant compared between the two groups.Conclusion:The results of this study show that the levosimendan group compared with the traditional cardiac drugs group the urine after surgery,LVEF,left heart and stroke volume SV increased,the left ventricular diameter reduced,central venous pressure,blood oxygen saturation,posto-perative length of hospital,postoperative dyspnea and cardiac functional grading,the treatment group is better than the control group.Levosimendan can obviously improve the patient's breathing difficulties and other symptoms and signs,improve the quality of life of patients.Levosimendan injection is safe and effective and can be used for mitral valve disease,and is expected to replace the other traditional positive inotropic drug types.