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| Clinical Efficacy of Levosimendan on Children with Low Cardiac Output Syndrome after Congenital Heart Disease and Its Influence on Renal Function |
| ZHANG Jian, DONG Yuan, GAO Jinxia, et al |
| The Sixth Hospital of Shijiazhuang, Hebei Shijiazhuang 050000, China |
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Abstract Objective: To analyze the clinical effect of levosimendan on children with low cardiac output syndrome (LCOS) after congenital heart disease (CHD) operation, and to observe its effect on renal function. Methods: A total of 42 children with LCOS complicated within 24h after CHD surgery in Shijiazhuang Maternal and Child Health Hospital from January 2019 to August 2020 and whose condition was not improved by conventional vasoactive drugs after surgery were selected, and they were treated with levosimendan injection. The basic conditions of the children during the perioperative period and the changes of hemodynamics indicators [heart rate (HR), systolic blood pressure (SBP), central venous pressure (CVP)], blood metabolic indicators [B-type brain natriuretic peptide level (NT-proBNP), cardiac troponin (cTnI), blood lactate (Lac )], vasoactivity indicators [cardiac output index (CI) level, vasoactive drug score (VIS)], renal function indicators [serum creatinine (Scr), cumulative fluid load] before (T0) and 24h (T1), 48h (T2), 72h (T3) after the application of levosimendan were observed and recorded. Results: The median time of cardiopulmonary bypass was 95.3 (69, 133) min; the median time of aortic occlusion was 63.8 (47, 143) min; the median time of auxiliary circulation was 48.9 (33, 115) min; the median time of tracheal intubation was 99.8 (60.9 , 164.6) h; the median time of PICU stay was 10.5 (6.0, 15.7) d; the median total hospitalization time was 32.3 (22.2, 47.1) d; 1 case (2.4%) died. Compared with time T0, HR showed a decreasing trend, SBP showed a rising trend at T1~T3 time (P<0.05), and there was no significant difference in CVP (P>0.05). The level of NT-proBNP in children at T1 was significantly higher than that at T0 (P<0.05), and gradually decreased to the level at T0 at T2~T3 (P>0.05); the levels of cTnI and Lac at T1~T3 were lower than those at T0 time (P<0.05). The VIS of children at T1 was significantly higher than that at T0 (P<0.05), and gradually decreased to the level at T0 at T2~T3 (P>0.05). The blood Scr of the children at T1~T2 first showed an upward trend, and then gradually decreased at T3, which was higher than that at T0 (P<0.05); the cumulative fluid load level of children at T1~T3 was lower than that at T0 (P<0.05).Conclusion: Levosimendan improved the systemic tissue perfusion level and enhanced myocardial contractility in children with LCOS without adverse effects such as cardiac arrhythmias, and had a protective effect on renal function, which was beneficial to the children's recovery.
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2022, Vol. 28 
