A Comparative Study Of The Clinical Efficacy Of Levosimendan And Milrinone In The Perioperative Period Of Mitral Valve Replacement Surgery

Objective: To study the difference of levosimendan and milrinone in the perioperative application of mitral valve replacement surgery on the recovery of cardiac function and protective effect on myocardial ischemia reperfusion injury.Methods: Subjects collected in 2016-2017,45 cases of patients with mitral valve disease in Linyi Central Hospital.All patients diagnosed met diagnostic criteria for clinical guidelines and mitral valve replacement surgery indications.Lines all patients coronary angiography were without coronary artery bypass.Before the operation,we performed four major routine examinations,blood type,biochemical and immunological examination,chest radiography,electrocardiogram,cardiac ultrasound,color Doppler ultrasound of neck blood vessel,pulmonary function,etc.No contraindication was found.Cardiac function of all patients was classified as ?-? according to NYHA(New York Heart Association).Before operation,12 cases of mitral insufficiency,24 cases of mitral stenosis and 9 cases of mitral valve disease with tricuspid valve disease were diagnosed.Exclusion criteria: surgical accidents,postoperative severe cardiac and brain complications,severe liver and kidney insufficiency.All into the group of patients were randomly divided into the leosimendan group(n=15),rice farmers group(n=15)and the control group(n=15).The leosimendan group in the control group on the basis of routine therapy in the preoperative 1 day for leosimendan treatment.With 12 ?g/(kg · min)the speed of intravenous 10 min,then to 0.1?g/(kg · min)are sustained.If patients can tolerate,2 h after dose increases to 0.2?g/(kg · min)and continued for 24 hours.M force farmers group of patients in the control group conventional treatment based on immediate postoperative to 0.25 ~ 1.0?g/(kg · min)continuous intravenous pumping m force farmers in 7 days.Reflect the cardiac function indexes,postoperative 24 h,48h,72 h testing in patients with brain natriuretic peptide precursor.Postoperative day 3,7 days heart colour to exceed examination monitoring left ventricular ejection fraction(EF).Reflect the heart meat ischemia-reperfusion injury index: in postoperative 12 h,24h,48 h,72h extraction in patients with venous blood,monitoring patients troponin I,LDH and CK-MB.The indexes of heart function and myocardial ischemia-reperfusion injury were compared in three groups at different time points.We can compare the clinical efficacy of Levimendan and milrinone in the perioperative period of mitral valve replacement.Results: There was no significant difference in age,sex,body weight,aortic occlusion time and NT-proBNP among the three groups(P > 0.05).Compared with thecontrol group,the concentration of plasma troponin I,LDH,CK-MB in T1,T2,T3,T4 in the milrinone group was lower(P<0.05 or P<0.01).Compared with milrinone group,the concentration of plasma troponin I,LDH,CK-MB in T1,T2,T3,T4 in the levosimendan group was lower(P<0.05 or P<0.01).Compared with the control group,NT-pro BNP in T2,T3,T4 in the milrinone group was lower(P<0.05 or P<0.01),and LVEF in D3,D7 in the milrinone group was higher(P<0.05 or P<0.01);compared with milrinone group,NT-proBNP in T1,T2,T3 in the levosimendan group was lower(P<0.05 or P<0.01),and LVEF in D3,D7 in the levosimendan group was higher(P<0.05 or P<0.01).Conclusion: In the perioperative period,levsimendan and milrinone were used in mitral valve replacement under cardiopulmonary bypass respectively.We found that both levomycin and milrinone could play a certain role in the recovery of heart function and the protective effect of myocardial ischemia reperfusion injury.The effect of levosimendan is more significant than that of milrinone,and the clinical effect is better.But whether it can improve the long-term survival rate and prognosis of patients needs to be confirmed by clinical trials.