社團法人臺灣臨床藥學會

已出刊文章

【綜合評述】探討Levosimendan 於重症病人之臨床應用與治療
To Explore the Clinical Application and Treatment of Levosimendan in Critically Illnesses
Levosimendan、急性心衰竭、心因性休克、敗血性休克、心腎症候群、Acute Heart Failure, Cardiogenic Shock, Septic Shock, Cardiorenal Syndrome
邱春吉Chun-Chi Chiou1,* 、王郁青Yu-Chin Lily Wang1
1長庚醫療財團法人高雄長庚紀念醫院藥劑部
Levosimendan 是鈣離子增敏劑,其增強心肌收縮作用是源於增加心肌鈣離子與troponin C 結合的敏感度,相較於其他強心劑,它可改善心肌的舒張功能且不會增加耗氧量;藉由打開血管平滑肌細胞上對三磷酸腺苷(adenosine triphosphate, ATP)敏感的鉀離子通道具有血管舒張作用;經由打開心肌細胞粒線體上對ATP 敏感的鉀離子通道而有心肌保護作用。levosimendan 作用快速,半衰期約1 小時,其活性代謝物半衰期長約80 小時,可延長作用時間(7 ~ 9 天)。Levosimendan 具備這些獨特的藥理學特性,除了被核可使用於急性失代償心衰竭外,臨床上也被應用於各類重症疾病之治療包括心因性休克、敗血性休克、肺高壓和右心室功能異常、心腎症候群、以及體外膜氧合器移除等。然而,由於這些潛在適應症之實證證據仍不完整或研究試驗之結果偶而呈現不一致性,需要更多高實證等級的研究和更進一步的臨床評估來驗證levosimendan 於這些潛在適應症的角色。本文將藉由文獻回顧,探討levosimendan 於重症病人之臨床應用與治療。
 
Levosimendan is a calcium sensitizer, its enhancement of myocardial contraction is as a result of increasing the sensitivity of myocardial calcium ions and troponin C. Compared with other inotropic agents, it can improve diastolic function without increasing oxygen consumption in the myocardium. It has a vasodilator effect by opening the potassium ion channel sensitive to adenosine triphosphate (ATP) on vascular smooth muscle cells and by opening the potassium ion channel sensitive to ATP on the mitochondria of cardiomyocytes to achieve cardio protection. Levosimendan has a fast onset of action with a half-life of 1 hour, its active metabolite half-life is about 80 hours, and the action time can prolong for 7–9 days. Levosimendan has these unique pharmacological properties, and it has been not only approved for acute decompensated heart failure but also applied clinically for various severe conditions including cardiogenic shock, septic shock, pulmonary hypertension and right ventricular dysfunction, cardiorenal syndrome, and weaning from extra-corporeal membrane oxygenation. However, because the empirical evidence for these potential indications is still incomplete or the results of research trials occasionally show inconsistencies, more high-level empirical studies and further clinical evaluations are needed to verify the role of levosimendan in these potential indications. Through the literature review and analysis, this article is to explore the clinical application and treatment of levosimendan in critically ill patients.

Summited for publication: 2021.1.28; Accepted for publication: 2021.5.21
操作進行中,請稍候~~~~
×
加载中...