Abstract：
Background: Various inotropes and inodilators have been utilized to treat low cardiac output syndrome after the arterial switch operation. The use of levosimendan, a calcium sensitizer has been limited in this setting. This study compares the effects of levosimendan with milrinone in managing low cardiac output after the arterial switch operation. Methods: A retrospective, comparative study was conducted in a tertiary care hospital on patients weighing up to 3 kg undergoing the arterial switch operation between January 2017 and January 2022. Patients received a loading dose followed by continuous infusion of either levosimendan or milrinone. Echocardiographic, hemodynamic and biochemical parameters were compared. Results: Forty-three patients received levosimendan and 42 patients received milrinone as the primary test drug. Cardiac index of less than 2.2 L/min/m2 on postoperative day 1 and 2 was found in 9.3% and 2.3% of patients receiving levosimendan versus 26.2% and 11.9% in those receiving milrinone, respectively (P = .04 and .08, respectively). Early lactate-clearance and better central venous oxygen saturations were noted in the levosimendan group. Prevalence of acute kidney injury was higher in the milrinone group (50% vs 28%; P = .03). Use of peritoneal dialysis in the milrinone group versus levosimendan was 31% and 16.3%, respectively (P = .11). There was no difference in hospital mortality between the groups (milrinone, 3; levosimendan, 2, P = .62). Conclusions: Levosimendan is safe and as effective as milrinone to treat low cardiac output syndrome occurring in neonates after the arterial switch operation. In addition we found that levosimendan was renal protective when compared with milrinone.
摘要：
背景：在动脉转换手术后，已使用各种强直剂和扩张剂来治疗低心输出量综合征。左西孟旦的使用，钙敏化剂在这种情况下受到限制。这项研究比较了左西孟旦和米力农在动脉转换手术后管理低心输出量的效果。方法：回顾性分析，我们在一家三级医院对2017年1月至2022年1月体重不超过3kg的动脉转换手术患者进行了对比研究.患者接受负荷剂量，然后连续输注左西孟旦或米力农。超声心动图,比较血液动力学和生化指标。结果：43例患者接受左西孟旦治疗，42例患者接受米力农作为主要试验药物。术后第1天和第2天的心脏指数小于2.2L/min/m2的患者分别为9.3％和2.3％，接受左西孟旦治疗的患者分别为26.2％和11.9％。分别（P=.04和.08，分别）。在左西孟旦组中注意到早期乳酸清除和更好的中心静脉氧饱和度。米力农组急性肾损伤的患病率更高（50％vs28％；P=0.03）。与左西孟旦相比，米力农组腹膜透析的使用率分别为31％和16.3％，分别(P=.11)。两组之间的住院死亡率没有差异(米力农，3；左西孟旦，2，P=.62）。结论:左西孟旦治疗新生儿动脉转换术后低心排血量综合征安全有效。此外，我们发现左西孟旦与米力农相比具有肾脏保护作用。
