2020 年第 4 期 第 15 卷

应用脉搏指示连续心排血量监测技术评价左西孟旦注射液联合参附注射液对重症射血分数降低型心力衰竭住院患者血流动力学的影响

Effect of levosimendan combined with Shenfu injection on hemodynamics monitored by pulse-indicator continuous cardiac output in patients with heart failure with reduced ejection fraction

作者：何刚1刘红旭2周琦2田伟2来晓磊2佟彤2周瑛3

英文作者：He Gang1 Liu Hongxu2 Zhou Qi2 Tian Wei2 Lai Xiaolei2 Tong Tong2 Zhou Ying3

单位：1北京中医药大学2017级中医内科学硕士研究生100029；2首都医科大学附属北京中医医院心血管科100010；3山东省青岛市即墨区人民医院肿瘤科266200

英文单位：1Grade 2017  Master Degree Candidate Chinese Internal Medicine Beijing University of Chinese Medicine Beijing 100029 China; 2Department of Cardiology Beijing Hospital of Traditional Chinese Medicine Capital Medical University Beijing 100010 China; 3Department of Oncology Jimo District People′s Hospital Shandong Province Qingdao 266200 China

关键词：心力衰竭；血流动力学；左西孟旦；参附注射液

英文关键词：Heartfailure；Hemodynamics；Levosimendan；Shenfuinjection

• 摘要：

• 【摘要】目的    应用脉搏指示连续心排血量（PICCO）监测技术观察左西孟旦注射液联合参附注射液对重症射血分数降低型心力衰竭(HFrEF)患者血流动力学的影响。方法    选取2016年9月至2018年11月在首都医科大学附属北京中医医院心脏重症监护病房住院的HFrEF患者32例，应用PICCO监测技术观察患者采用左西孟旦注射液联合参附注射液治疗0、2、24 h的血流动力学指标，包括有创动脉压［收缩压、舒张压和有创测量平均压(IMBP)］、心率、心排指数、每搏输出量指数（SVI）、外周血管阻力指数（SVRI）、胸腔血容量指数（ITBI）。结果    给药24 h后患者收缩压、舒张压、IMBP均明显高于给药0 h［（115±14）mmHg(1 mmHg=0.133 kPa)比（93±11）mmHg、（72±8）mmHg比（45±5）mmHg、（86±11）mmHg比（61±8）mmHg］，差异均有统计学意义（均P＜0.05）。给药2 h后患者心率明显高于给药0 h［（121±14）次/min比（115±13）次/min］，给药24 h后心率［（109±13）次/min］明显低于给药0 h，差异均有统计学意义（均P＜0.05）。给药2、24 h后患者心排指数、SVI均明显高于给药0 h［（2.6±0.9）、（3.7±1.4）L/(min·m2)比（2.1±0.6）L/(min·m2)；（24.8±3.2）、（37.9±3.8）ml/m2比（20.7±2.7）ml/m2］，SVRI均明显低于给药0 h［（2 669±169）、（2 826±174）dyn·sec·m2/cm5比（3 820±213）dyn·sec·m2/cm5］（均P＜0.05）。给药0、2、24 h患者ITBI比较，差异无统计学意义（P＞0.05）。结论    左西孟旦注射液联合参附注射液可以提高HFrEF患者血压、心肌收缩力，增加患者的心排血量，并能减低患者的心脏后负荷，还可以在用药初始有效预防低血压的发生，经PICCO监测技术，两药联合应用可以有效实现血流动力学疗效的叠加及不良反应的降低，可以作为一种有效的临床联合用药方案应用于HFrEF患者的治疗。

• 【Abstract】Objective    To investigate the effect of levosimendan combined with Shenfu injection on hemodynamics, which is observed by pulse-indicator continuous cardiac output(PICCO) monitoring technique in patients with heart failure with reduced ejection fraction(HFrEF). Methods    From September 2016 to November 2018, 32 HFrEF patients admitted to the cardiac intensive care unit of Beijing Hospital of Traditional Chinese Medicine, Capital Medical University were monitored by PICCO technology. The patients were treated with levosimendan and Shenfu injection. Hemodynamic indexes including invasive arterial pressure［systolic blood pressure, diastolic blood pressure and invasive mean blood pressure(IMBP)］, heart rate, cardiac output index, stroke output index(SVI), systemic vascular resistance index(SVRI) and intra-thoracic blood volume index(ITBI) were observed at 0, 2, 24 h after treatment. Results    Systolic blood pressure, diastolic blood pressure and IMBP at 24 h after medication were significantly higher than those at 0 h［（115±14）mmHg vs （93±11）mmHg, （72±8）mmHg vs （45±5）mmHg, （86±11）mmHg vs （61±8）mmHg］(all P＜0.05). Heart rate significantly increased at 2 h［（121±14）times/min］ and decreased at 24 h［（109±13）times/min］ compared with that at 0 h［（115±13）times/min］(all P＜0.05). At 2, 24 h after medication, cardiac output index and SVI were significantly higher than those at 0 h［（2.6±0.9）,（3.7±1.4）L/(min·m2) vs （2.1±0.6）L/(min·m2)； （24.8±3.2）,（37.9±3.8）ml/m2 vs （20.7±2.7）ml/m2］; SVRI was significantly lower than that at 0 h［（2 669±169）,（2 826±174）dyn·sec·m2/cm5 vs （3 820±213）dyn·sec·m2/cm5］(all P＜0.05). There were no significant changes of ITBI at 0, 2, 24 h after treatment(all P＞0.05). Conclusions    Levosimendan combined with Shenfu injection treating HFrEF patients can improve blood pressure and myocardial contractility, increase cardiac output and reduce cardiac afterload. It can also effectively prevent hypotension at the beginning of medication. With PICCO monitoring, levosimendan combined with Shenfu injection shows good therapeutic efficacy and few side effects, which suggests the feasibility and practicability of the combination regimen in clinical practice.