Альманах клинической медицины. 2015; : 142-148
ЛЕВОСИМЕНДАН В ИНТЕНСИВНОЙ ТЕРАПИИ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ ПРИ ПРОТЕЗИРОВАНИИ КЛАПАНОВ СЕРДЦА
https://doi.org/10.18786/2072-0505-2015-38-142-148Аннотация
В статье содержится описание периоперационного периода двух пациентов, которым выполнялась коррекция приобретенных пороков клапанов сердца в условиях искусственного кровообращения. В обоих наблюдениях развилась декомпенсация хронической сердечной недостаточности, для ее купирования был использован левосимендан (препарат Симдакс, Orion Pharma, Финляндия). В первом случае препарат вводился в раннем послеоперационном периоде, без нагрузочной дозы, со скоростью 0,05–0,1 мкг/кг/мин в течение 26 часов. Положительный эффект отмечен через 3 часа, через 36 часов отключены классические инотропные препараты, и еще через 36 часов (на 3-и сутки) больной переведен в палату хирургического отделения. Во втором случае в связи с экстремально низким сердечным индексом левосимендан использовался профилактически за сутки до операции. Тем не менее длительный период искусственного кровообращения, нарушения перфузии во время искусственного кровообращения в виде тромбозов привели к декомпенсации хронической почечной недостаточности, хронической сердечной недостаточности и летальному исходу в первые 10 часов после операции.
Заключение. Левосимендан – эффективный препарат для лечения сердечной недостаточности у кардиохирургических больных, однако трудно рассчитывать на то, что он в состоянии решить все проблемы раннего послеоперационного периода при полиорганной недостаточности.
Список литературы
1. Figgitt DP, Gillies PS, Goa KL. Levosimendan. Drugs. 2001;61(5):613–27.
2. Явелов ИС. Клиническая эффективность сенситизатора кальция – представителя нового класса препаратов с положительным инотропным действием при сердечной недостаточности и инфаркте миокарда. Сердечная недостаточность. 2005;(1):33–45. Yavelov IS. Klinicheskaya effektivnost' sensitizatora kal'tsiya – predstavitelya novogo klassa preparatov s polozhitel'nym inotropnym deystviem pri serdechnoy nedostatochnosti i infarkte miokarda [Clinical efficacy of the calcium sensitizer, a representative of a new class of drugs with a positive inotropic effect in heart failure and myocardial infarction]. Serdechnaya nedostatochnost' [Journal of Heart Failure]. 2005;(1):33–45 (in Russian).
3. Государственный реестр лекарственных средств. Инструкция по медицинскому применению препарата Симдакс (Simdax). 2007: 1–8. Инструкция по медицинскому применению препарата СИМДАКС. 2009:1–12. The State Registry of pharmaceuticals (Russian Federation). Instruction on medical use of Symdax. 2007: 1–8. Instruction on medical use of SYMDAX. 2009: 1–12 (in Russian).
4. Моисеев ВС. Острая сердечная недостаточность. Новые возможности лечения с применением сенситизатора кальция левосимендана. М.: Фарма Пресс; 2004. Moiseev VS. Ostraya serdechnaya nedostatochnost'. Novye vozmozhnosti lecheniya
5. s primeneniem sensitizatora kal'tsiya levosimendana [Acute heart failure. New possibilities of treatment with the use of a calcium sensitizer levosimendan]. Moscow: Farma Press; 2004.
6. Haikala H, Nissinen E, Etemadzadeh E, Levijoki J, Linden IB. Troponin C-mediated calcium sensitization induced by levosimendan does not impair relaxation. J Cardiovasc Pharmacol. 1995;25(5):794–801.
7. Белоусов ЮБ, Белоусов ДЮ, Григорьев ВЮ, Бекетов АС, Попова НЮ, Бойко ЕА, Медников ОИ. Фармакоэкономический анализ применения левосимендана у больных с тяжелой декомпенсированной хронической сердечной недостаточностью. Сердечная недостаточность. 2006;(1):32–8. Belousov YuB, Belousov DYu, Grigor'ev VYu, Beketov AS, Popova NYu, Boyko EA, Mednikov OI. Farmakoekonomicheskiy analiz primeneniya levosimendana u bol'nykh s tyazheloy dekompensirovannoy khronicheskoy serdechnoy nedostatochnost'yu [Pharmacoeconomical analysis of levosimendane treatment in patients with severe, decompensated chronic heart failure]. Serdechnaya nedostatochnost' [Journal of Heart Failure]. 2006;(1):32–8 (in Russian).
8. Gheorghiade M, Teerlink JR, Mebazaa A. Pharmacology of new agents for acute heart failure syndromes. Am J Cardiol. 2005;96(6A): 68G–73G.
9. Ukkonen H, Saraste M, Akkila J, Knuuti J, Karanko M, Iida H, Lehikoinen P, Nagren K, Lehtonen L, Voipio-Pulkki LM. Myocardial efficiency during levosimendan infusion in congestive heart failure. Clin Pharmacol Ther. 2000;68(5):522–31.
10. Монография Симдакс (левосимендан). Орион фарма. Доступно на: http://www.orionpharma.com.ua/OrionPharmaUA_Global/leaflets/simdax%20promo.pdf Symdax (levosimendan) Product Monograph. Orion Pharma. Available from: http://www.orionpharma.com.ua/OrionPharmaUA_Global/leaflets/simdax%20promo.pdf (in Rus sian).
11. Kaheinen P, Pollesello P, Levijoki J, Haikala H. Levosimendan increases diastolic coronary flow in isolated guinea-pig heart by opening ATP-sensitive potassium channels. J Cardiovasc Pharmacol. 2001;37(4):367–74.
12. Alvarez J, Taboada M, Rodriguez J, Caruezo V, Bouzada M, Campana O, Bascuas B, Perez-Paz J, Ginesta V. Hemodynamic effects of levosimendan following cardiac surgery. Rev Esp Anestesiol Reanim. 2005;52(7):389–94.
13. Maytin M, Colucci WS. Cardioprotection: a new paradigm in the management of acute heart failure syndromes. Am J Cardiol. 2005;96(6A):26G–31G.
14. Papp Z, Csapo K, Pollesello P, Haikala H, Edes I. Pharmacological mechanisms contributing to the clinical efficacy of levosimendan. Cardiovasc Drug Rev. 2005;23(1):71–98.
15. Lilleberg J, Nieminen MS, Akkila J, Heikkila L, Kuitunen A, Lehtonen L, Verkkala K, Mattila S, Salmenpera M. Effects of a new calcium sensitizer, levosimendan, on haemodynamics, coronary blood flow and myocardial substrate utilization early after coronary artery bypass grafting. Eur Heart J. 1998;19(4):660–8.
16. Demeyere R, Herrijgers P, Flameng W. Haemodynamic effects of levosimendan, a novel calcium sensitizer, in patients during weaning from cardiopulmonary bypass. Crit Care. 2002;6(Suppl 1):S65–6.
17. Labriola C, Siro-Brigiani M, Carrata F, Santangelo E, Amantea B. Hemodynamic effects of levosimendan in patients with low-output heart failure after cardiac surgery. Int J Clin Pharmacol Ther. 2004;42(4):204–11.
18. Harjola V, Siirila K, Suojaranta-Ylinen R. Levosimendan in cardiac surgery [abstract A495]. Crit Care. 2004;8 (Suppl 1):P83–90.
19. Lasonidou C, Karakasis T, Vasiliadou G. Hemodynamic effects of the new calcium sensitizer levosimendan in cardiosurgical ICU patients [abstract A285]. Crit Care. 2004;8(Suppl 1): P83–90.
20. Landoni G, Augoustides JG, Guarracino F, Santini F, Ponschab M, Pasero D, Rodseth RN, Biondi-Zoccai G, Silvay G, Salvi L, Camporesi E, Comis M, Conte M, Bevilacqua S, Cabrini L, Cariello C, Caramelli F, De Santis V, Del Sarto P, Dini D, Forti A, Galdieri N, Giordano G, Gottin L, Greco M, Maglioni E, Mantovani L, Manzato A, Meli M, Paternoster G, Pittarello D, Rana KN, Ruggeri L, Salandin V, Sangalli F, Zambon M, Zucchetti M, Bignami E, Alfieri O, Zangrillo A. Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference. Acta Anaesthesiol Scand. 2011;55(3):259–66.
Almanac of Clinical Medicine. 2015; : 142-148
LEVOSIMENDAN FOR INTENSIVE THERAPY OF HEART FAILURE IN HEART VALVE PROSTHETICS
https://doi.org/10.18786/2072-0505-2015-38-142-148Abstract
The article describes perioperative periods of two patients who underwent surgical repair of acquired heart valve disease with artificial circulatory support. In both cases, there was decompensation of chronic heart failure, with levosimendan (Symdax, Orion Pharma, Finland) being used for its treatment. In the first case the drug was infused in the early postoperative period, without a loading dose, at a rate of 0.05–0.1 mcg/kg/min for 26 hours. After 3 hours, an improvement was observed and after 36 hours classic inotropes were stopped. After further 36 hours (day 3) the patient was moved to a surgical department ward. In the second case, due to an extremely low cardiac index, levosimendan was administered proactively starting one day before surgery. However, a long period of artificial circulation, perfusion problems due to thrombosis during artificial circulatory support led to deterioration of chronic renal failure, chronic heart failure and to death within the first 10 hours after surgery. Conclusion: Levosimendan is an effective drug for treatment of heart failure in cardiac surgery patients. However, it is unlikely to solve all problems of early postoperative period in patients with multiple organ failure.
References
1. Figgitt DP, Gillies PS, Goa KL. Levosimendan. Drugs. 2001;61(5):613–27.
2. Yavelov IS. Klinicheskaya effektivnost' sensitizatora kal'tsiya – predstavitelya novogo klassa preparatov s polozhitel'nym inotropnym deistviem pri serdechnoi nedostatochnosti i infarkte miokarda. Serdechnaya nedostatochnost'. 2005;(1):33–45. Yavelov IS. Klinicheskaya effektivnost' sensitizatora kal'tsiya – predstavitelya novogo klassa preparatov s polozhitel'nym inotropnym deystviem pri serdechnoy nedostatochnosti i infarkte miokarda [Clinical efficacy of the calcium sensitizer, a representative of a new class of drugs with a positive inotropic effect in heart failure and myocardial infarction]. Serdechnaya nedostatochnost' [Journal of Heart Failure]. 2005;(1):33–45 (in Russian).
3. Gosudarstvennyi reestr lekarstvennykh sredstv. Instruktsiya po meditsinskomu primeneniyu preparata Simdaks (Simdax). 2007: 1–8. Instruktsiya po meditsinskomu primeneniyu preparata SIMDAKS. 2009:1–12. The State Registry of pharmaceuticals (Russian Federation). Instruction on medical use of Symdax. 2007: 1–8. Instruction on medical use of SYMDAX. 2009: 1–12 (in Russian).
4. Moiseev VS. Ostraya serdechnaya nedostatochnost'. Novye vozmozhnosti lecheniya s primeneniem sensitizatora kal'tsiya levosimendana. M.: Farma Press; 2004. Moiseev VS. Ostraya serdechnaya nedostatochnost'. Novye vozmozhnosti lecheniya
5. s primeneniem sensitizatora kal'tsiya levosimendana [Acute heart failure. New possibilities of treatment with the use of a calcium sensitizer levosimendan]. Moscow: Farma Press; 2004.
6. Haikala H, Nissinen E, Etemadzadeh E, Levijoki J, Linden IB. Troponin C-mediated calcium sensitization induced by levosimendan does not impair relaxation. J Cardiovasc Pharmacol. 1995;25(5):794–801.
7. Belousov YuB, Belousov DYu, Grigor'ev VYu, Beketov AS, Popova NYu, Boiko EA, Mednikov OI. Farmakoekonomicheskii analiz primeneniya levosimendana u bol'nykh s tyazheloi dekompensirovannoi khronicheskoi serdechnoi nedostatochnost'yu. Serdechnaya nedostatochnost'. 2006;(1):32–8. Belousov YuB, Belousov DYu, Grigor'ev VYu, Beketov AS, Popova NYu, Boyko EA, Mednikov OI. Farmakoekonomicheskiy analiz primeneniya levosimendana u bol'nykh s tyazheloy dekompensirovannoy khronicheskoy serdechnoy nedostatochnost'yu [Pharmacoeconomical analysis of levosimendane treatment in patients with severe, decompensated chronic heart failure]. Serdechnaya nedostatochnost' [Journal of Heart Failure]. 2006;(1):32–8 (in Russian).
8. Gheorghiade M, Teerlink JR, Mebazaa A. Pharmacology of new agents for acute heart failure syndromes. Am J Cardiol. 2005;96(6A): 68G–73G.
9. Ukkonen H, Saraste M, Akkila J, Knuuti J, Karanko M, Iida H, Lehikoinen P, Nagren K, Lehtonen L, Voipio-Pulkki LM. Myocardial efficiency during levosimendan infusion in congestive heart failure. Clin Pharmacol Ther. 2000;68(5):522–31.
10. Monografiya Simdaks (levosimendan). Orion farma. Dostupno na: http://www.orionpharma.com.ua/OrionPharmaUA_Global/leaflets/simdax%20promo.pdf Symdax (levosimendan) Product Monograph. Orion Pharma. Available from: http://www.orionpharma.com.ua/OrionPharmaUA_Global/leaflets/simdax%20promo.pdf (in Rus sian).
11. Kaheinen P, Pollesello P, Levijoki J, Haikala H. Levosimendan increases diastolic coronary flow in isolated guinea-pig heart by opening ATP-sensitive potassium channels. J Cardiovasc Pharmacol. 2001;37(4):367–74.
12. Alvarez J, Taboada M, Rodriguez J, Caruezo V, Bouzada M, Campana O, Bascuas B, Perez-Paz J, Ginesta V. Hemodynamic effects of levosimendan following cardiac surgery. Rev Esp Anestesiol Reanim. 2005;52(7):389–94.
13. Maytin M, Colucci WS. Cardioprotection: a new paradigm in the management of acute heart failure syndromes. Am J Cardiol. 2005;96(6A):26G–31G.
14. Papp Z, Csapo K, Pollesello P, Haikala H, Edes I. Pharmacological mechanisms contributing to the clinical efficacy of levosimendan. Cardiovasc Drug Rev. 2005;23(1):71–98.
15. Lilleberg J, Nieminen MS, Akkila J, Heikkila L, Kuitunen A, Lehtonen L, Verkkala K, Mattila S, Salmenpera M. Effects of a new calcium sensitizer, levosimendan, on haemodynamics, coronary blood flow and myocardial substrate utilization early after coronary artery bypass grafting. Eur Heart J. 1998;19(4):660–8.
16. Demeyere R, Herrijgers P, Flameng W. Haemodynamic effects of levosimendan, a novel calcium sensitizer, in patients during weaning from cardiopulmonary bypass. Crit Care. 2002;6(Suppl 1):S65–6.
17. Labriola C, Siro-Brigiani M, Carrata F, Santangelo E, Amantea B. Hemodynamic effects of levosimendan in patients with low-output heart failure after cardiac surgery. Int J Clin Pharmacol Ther. 2004;42(4):204–11.
18. Harjola V, Siirila K, Suojaranta-Ylinen R. Levosimendan in cardiac surgery [abstract A495]. Crit Care. 2004;8 (Suppl 1):P83–90.
19. Lasonidou C, Karakasis T, Vasiliadou G. Hemodynamic effects of the new calcium sensitizer levosimendan in cardiosurgical ICU patients [abstract A285]. Crit Care. 2004;8(Suppl 1): P83–90.
20. Landoni G, Augoustides JG, Guarracino F, Santini F, Ponschab M, Pasero D, Rodseth RN, Biondi-Zoccai G, Silvay G, Salvi L, Camporesi E, Comis M, Conte M, Bevilacqua S, Cabrini L, Cariello C, Caramelli F, De Santis V, Del Sarto P, Dini D, Forti A, Galdieri N, Giordano G, Gottin L, Greco M, Maglioni E, Mantovani L, Manzato A, Meli M, Paternoster G, Pittarello D, Rana KN, Ruggeri L, Salandin V, Sangalli F, Zambon M, Zucchetti M, Bignami E, Alfieri O, Zangrillo A. Mortality reduction in cardiac anesthesia and intensive care: results of the first International Consensus Conference. Acta Anaesthesiol Scand. 2011;55(3):259–66.
