Levosimendan 可增加心臟收縮並擴張血管來降低心臟前後負荷，在臺灣核准的 適應症為短期治療因傳統治療方式無效且適用強心劑治療之急性失代償性慢性心衰竭。低心輸出量症 (low cardiac output syndrome, LCOS) 為心臟手術後可能出現的併發症，會導致住院時間延長或增加死亡風險。過去文獻指出 levosimendan 曾用於 LCOS 的治療與預防，因此本文主要藉由文獻回顧來探討 levosimendan 是否可降低心臟手術後發生 LCOS 的機率，或改善已發生 LCOS 的預後。結果顯示，心臟手術前後預防或治療性使用 levosimendan，能改善血液動力學指標與降低 LCOS 的發生，但可能增加低血壓發生率。腎功能方面，使用 levosimendan 可降低急性腎損傷發生率和腎臟血管阻力，改善心臟手術後腎臟血流和腎絲球過濾率。目前各篇研究方法、試驗終點不盡相同、收案人數較少，因此未來仍需大型的試驗來驗證相關結果。

 

Levosimendan is a positive inotropic agent with vasodilating properties, which decreases both cardiac preload and afterload. In Taiwan, levosimendan is indicated for short-term treatment of patients with acute decompensated heart failure when conventional therapies are insufficient and inotropic support is required. Low cardiac output syndrome (LCOS) is a possible complication post cardiac surgery, thus prolonging length of hospital stay or increasing mortality. Literature review in the past indicated that levosimendan can be used in the management and prevention of LCOS. In this literature review, the current available evidence was analyzed if this medication was able to lower the risk of LCOS post cardiac surgery or improve the prognosis of LCOS patients. The results indicated that levosimendan improved hemodynamic index and decreased the risk of LCOS; however, hypotension occurred more frequently. In terms of renal function, levosimendan can reduce acute renal injury and renal vascular resistance, improve renal blood flow post cardiac surgery and estimated glomerular filtration rate. The studies included in this article differ in methodology and endpoints as well as limitation in small population size. Further studies are required to support this conclusion.

 

Summited for publication:2021.7.16; Accepted for publication: 2022.4.20