Short-term Efficacy Of Administration Of Levosimendan In Patients With Cardiogenic Shock

ObjectiveTo evaluate the short-term clinical efficacy of administration of levosimendan in patients with cardiogenic shock.MethodsA total of 74 patients were admitted and divided into levosimendan group(n=38)and control group(n=36)according to the use of levosimendan.The two groups were both given conventional treatment,including general treatment such as oxygen uptaking and electrocardiograph monitoring,vasoactive agents and the treatment of basic diseases,including coronary reperfusion therapy,antithrombotic,anti-ischemia,anti-inflammation and mechanical circulatory support necessarily.There were 21 patients and 19 patients who were implanted into the Swan-Ganz catheter for invasive hemodynamic monitoring in levosimendan group and control group,respectively.Levosimendan was administered as an initial loading dose of 12ug/kg delivered over 10 min followed by a continuous infusion of 0.1ug/kg/min for 24 hours.The dose may be halved or doubled.Mean arterial pressure(MAP),heart rate(HR),cardiac index(CI)and pulmoary capillary wedge pressure(PCWP)were assessed at baseline,6 hours,12 hours,24 hours,48 hours and 72 hours after the start of infusion.Echocardiography was performed to measure left ventricular ejection fraction(LVEF)and left ventricle end-diastolic diameter(LVDD)at baseline and 48-72 h after the start of infusion.Arterial blood lactate level was analysed before and 24 hours after treatment to calculate the removal rate of lactate in 24 hours.B-type natriuretic peptide(BNP)plasma level was analysed before and 48-72 hours after treatment.Moreover.The days of CCU stay and major complications(bleeding,arrhythmia and infection)of the both groups were recorded.Observe and record in-hospital mortality of both groups.Observe and record the rate of discharge,30 days and 90 days survival rate of both groups.Results1.The improvement of hemodynamics of levosimendan group was superior to that of control group: CI and PCWP were better in levosimendan group than those in the control group after treatment.The PCWP was significantly lower in levosimendan group than that in control group at 24 hours,48 hours and 72 hours after treatment(P <0.05).The CI was significantly higher in levosimendan group than that in control group at 6 hours,12 hours and 24 hours after treatment(P<0.05).After treatment,MAP was evidently higher and HR was evidently lower(P<0.05).There was no statistical difference between the two groups in MAP and HR(P> 0.05).2.Parameters reflecting cardiac function: The LVEF was significantly higher in both groups after treatment(P<0.05).The improvement of LVEF in levosimendan group was obviously superior to that of control group after treatment(P<0.05).The LVDD after treatment in two groups was no difference compared with that of before treatment(P>0.05).The BNP and lactate decreased obviously(P<0.05)in both groups compared with before treatment,however,the levosimendan group got lower(P<0.05).3.Arterial blood lactate clearance rate in 24 hours: The arterial blood lactate clearance rate was obviously higher in the levosimendan group than the control group(P<0.05).4.No significant difference existed in the days of CCU stay and the main complications(bleeding,arrhythmia and infection)between the two groups(P<0.05).5.There was no statistically difference in the rate of discharge between the two groups(P=0.247),but the levosimendan group was 13.5% higher.The 30 days and 90 days survival rate was respectively 1.729 times and 2.105 times of the control group,but the difference was not significant(P=0.145 and P=0.069,respectively).Conclusion1.Levosimendan can improve the hemodynamic status of patients in cardiogenic shock,improve cardiac function and alleviate pulmonary congestion.2.Levosimendan can reduce the level of lactate in patients with cardiogenic shock.3.Intravenous levosimendan in treating patiens with cardiogenic shock was secure.