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在接受冠状动脉旁路移植的低射出率患者中,Levosimendan对低心力输出综合征的影响:LICORN随机临床试验
Bernard Cholley1, Thibaut Caruba2, Sandrine Grosjean3
1Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, and University Paris Descartes-Sorbonne Paris Cité, Paris, France.
JAMA
|August 9, 2017
概括
在接受冠状动脉旁路移植的患者中,手术前使用levosimendan并没有显著减少左心室功能受损. 这种药物在预防重大不良事件方面没有益处.
科学领域:
- 心脏病学
- 心脏外科
- 药理学
背景情况:
- 低心力输出综合征 (LCOS) 是心脏手术后的严重并发症,特别是在左心室功能减弱的患者中,导致高发病率和死亡率.
- 确定有效的预防LCOS策略对于改善心脏手术患者的结果至关重要.
研究的目的:
- 评估术前levosimendan输液在治疗冠状动脉绕道移植 (CABG) 患者,左心室喷射分数 (LVEF) 受损的患者中预防术后低心输出综合征 (LCOS) 的疗效.
主要方法:
- 在法国13个心脏外科中心进行了一项随机双盲,安慰剂对照试验.
- 预计进行心肺旁路术的LVEF≤40%的患者接受了24小时的Levosimendan输液 (0. 1μg/ kg/ min) 或安慰剂,在麻醉诱导后开始.
- 主要终点是长时间注射甲醇胺,需要机械辅助装置或在指定的术后期进行置换疗法.
主要成果:
- 综合主终点发生在接受levosimendan的52%的患者和接受安慰剂的61% (绝对风险差异: - 7%;95%CI, - 17%至3%;P=.
- 根据LVEF,手术类型或手术前药物使用,亚组分析没有发现显著的相互作用.
- 在Levosimendan和安慰剂组中,不良事件的发生率,包括低血压和心房动,没有显著差异.
结论:
- 在接受CABG且LVEF受损的患者中,术前使用levosimendan并没有显著降低低心脏输出综合征的综合终点的发生率.
- 这些发现不支持在这种特定患者群体中常规使用levosimendan来预防LCOS.
- 可能需要进一步的研究来探索高风险心脏手术患者的LCOS治疗的替代策略.
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