Clinical Comparison Of Levosimendan And Dobutamine In The Treatment Of Sepsis-induced Myocardial Dysfunction

Objective:To compare the therapeutic effect of levosimendan and dobutamine on sepsis myocardial inhibition patients,the same time to explore the safety of the use of levosimendan and the effect on prognosis.Methods:This project is a single-center,prospective randomized controlled trial in a third-class hospital in Kunming,Yunnan Province.referring to relevant standards,a total of 40 patients with sepsis myocardial inhibition admitted to the emergency department of a third class hospital in kunming,yunnan province from september 2018 to december 2019 were included.patients who were excluded or lost in midway were not involved in the study.According to the time of admission and the method of random number table.20 cases were divided into observation group(treatment with levosimendan)and control group(treatment with dobutamine).The patients in the group were treated with basic symptomatic support,and the patients in the observation group were treated with levosimendan 12.5 mg+5%glucose sodium chloride solution 45 ml,the initial administration rate was 0.1?g/kg/min,so that the rate of infusion was 24 h,and the rate of administration was adjusted according to the actual situation of the patients and the results of echocardiography.The control group was treated with dobutamine 180 mg 5%glucose sodium chloride solution 32 ml,the initial infusion rate was 2?g/kg/min,continuous intravenous injection 24 h treatment,and according to the actual situation and echocardiography results,appropriate adjustment of the rate of administrationThe general data and primary infection sites of the two groups were recorded.left ventricular ejection fraction(LVEF),cardiac output index(CI),brain natriuretic peptide(BNP),troponin(cTnI)levels,acute physiology and chronic health status scores(Acute Physiology and Chronic Health Evaluation?,APACHE ?),lactate(Lac),heart rate(HR),blood pressure(MAP),and statistics of adverse reactions,duration of mechanical ventilation,total hospital stay,all-cause mortality during hospitalization,and survival at 28 days of discharge.Statistical analysis using SPSS 19.0 statistical software package statistical analysis,counting data using example and composition ratio,normal distribution measurement data using mean ±standard deviation,normal distribution measurement data between two groups using two independent sample t test,paired design normal distribution measurement data comparison using paired t test,counting data between two groups using ?2 test,repeated data comparison of different time points of normal distribution measurement data between two groups using repeated variance analysis,K-M test was used for survival analysis,and P<0.05 was statistically significant.Results:(1)There was no significant difference in age,BMI,Apache ? score,SOFA score,LVEF,CI,BNP,cTnI,MBP,HR,Lac by independent sample t test before treatment(P>0.05),There was no significant difference between the two groups(P>0.05);(2)After 24 hours,48 hours and 72 hours of treatment,the results of the comparison of cardiac function indexes between the two groups showed that the effect test of cTnI was:F=13.332,P=0.001;intersubjective effect test:F=5.053,P=0.029;BNP test:F=23.579,P<0.001;intersubjective effect test:F=6.021,P=0.021;It can be considered that time is the influencing factor of cTnI and BNP,and cTnI and BNP decrease with the extension of time,and there is statistical difference between the two groups(P<0.05).Internal effects test of LVEF:F=51.426,P<0.001;Intersubjective effects test:F=4.296,P=0.043;Internal effects test of CI:F=17.617,P<0.001;Intersubjective effects test:F=5.014,P=0.028,lt can be considered that time is the influencing factor of LVEF and CI.LVEF and CI have improved with the extension of time,and there are statistical differences in LVEF and CI between the two groups(P<0.05).(3)The lactic acid in the levosimendan group and the dobutamine group was lower than the baseline value 72 hours after treatment,and the difference between groups was statistically significant(P<0.05);(4)In this study,after 72 hours of medication,the levosimendan group APACHE? score:F=6.893,P=0.012,the inter-subject effect test:F=3.395.P=0.073,the APACHE? score improved with time,but there was no statistical difference between the two groups(P=0.073).the MAP intra-subject effect test:F=27.885,P=0.001;inter-subject effect test:F=2.343,P=0.134;MAP improved over time and there was no statistical difference between the two groups(P=0.134).The intra-subject effect test of heart rate was:F=1.479,P=0.231;inter-subject effect test:F=0.211,P=0.649;heart rate did not change significantly over time,and there was no statistical difference in heart rate between the two groups(P=0.649).mechanical ventilation time[(12.17±10.31)vs(13.00±9.44)d,(P>0.05)],total hospitalization time[(17.95±9.98)vs(14.90±8.00)d,(P>0.05)]norepinephrine dosage[(60.65±27.6)vs(70.50±32.582),(P<0.05)]were statistically significant.adverse reaction occurrence and all-cause mortality during hospitalization were not statistically significant(P>0.05).Conclusion:Levosimendan is better than dobutamine to improve cardiac function index,stabilize hemodynamics,improve tissue perfusion,and no serious adverse reactions occur in sepsis patients with myocardial inhibition.However,there is no obvious advantage in improving the overall condition and prognosis.more prospective,large-scale,multi-center clinical studies are still expected to be further explored.