【摘要】 目的观察静脉注射米力农对住院急性心力衰竭综合征(AHFS)患者血流动力学和心功能的影响。方法选择2015年9月~2017年3月于北京市石景山医院住院的120例AHFS患者,入院48 h内进行肺动脉导管监测。研究对象在常规治疗基础上,随机分为4组:0.5μg米力农(低剂量组)、1.0μg米力农(中剂量组)、1.5μg米力农(高剂量组)和安慰剂组,每组30例,通过生理盐水配成不同剂量米力农(鲁南贝特制药有限公司;规格:5 ml:5 mg×2支),安慰剂组给予生理盐水。米力农或生理盐水通过输液泵静脉注射,速率为100 ml/h,持续时间为6 h。然后观察所有研究对象米力农治疗前后的肺毛细血管楔压(PCWP)、心脏指数(CI)、平均右心房压(RAP)和每搏功指数(SWI)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)和左室射血分数(LVEF)。结果 120例研究对象,其中男性105例,平均年龄是(55±11)岁。四组患者组间在性别、年龄、病因、基线血流动力学及心功能无统计学差异(P>0.05)。治疗结束后,安慰剂组PCWP变化是0.0 mm Hg;低剂量组变化-3.2mm Hg,中剂量组变化-3.3 mm Hg,高剂量组变化-4.7 mm Hg。与安慰剂组相比,米力农各组PCWP均显著降低,差异有统计学意义(P均<0.05),并呈剂量依赖性。治疗后中剂量组和高剂量组收缩压明显增高,而且高剂量组高于中剂量组,差异有统计学意义(P均<0.05)。与安慰剂组比较,所有剂量米力农组患者心率均降低,并呈剂量依赖性(P均<0.05)。与安慰剂组比较,高剂量组患者CI增加,差异有统计学意义(P<0.05)。中剂量组患者LVESV降低明显高于安慰剂组(P=0.03)。而低剂量和高剂量组平均变化与安慰组相比较均无统计学差异(P>0.05)。高剂量组治疗后LVEDV降低明显高于安慰剂组(P=0.02)。而低剂量和中剂量组平均变化与安慰组相比较均无统计学差异。结论大剂量米力农可改善AHFS患者PCWP,增加收缩压并降低心率。更多还原

【Abstract】 Objective To observe the influence of intravenous injection of milrinone on hemodynamics and heart function in patients with acute heart failure syndromes(AHFS). Methods AHFS patients(n=120) were chosen from the Beijing Shijingshan Hospital from Sept. 2015 to Mar. 2017, and monitored with pulmonary artery catheter within 48 h after hospitalization. The patients were randomly divided into 4 groups: low-dose milrinone group(0.5 μg), mid-dose milrinone group(1.0 μg), high-dose milrinone group(1.5 μg) and placebo group(normal saline, each n=30). Milrinone or normal saline were injected intravenously through infusion pump in a velocity of 100 m L/h for 6 h. The indexes of pulmonary capillary wedge pressure(PCWP), cardiac index(CI), mean right atrial pressure(MRAP), stroke work index(SWI), left ventricular end systolic diameter(LVESD), left ventricular end diastolic diameter(LVEDD) and left ventricular ejection fraction(LVEF) were observed in all groups before and after treatment. Results In 120 patients, 105 were male ones and their average age=(55±11). The difference in sex, age, disease causes, baseline hemodynamics and heart function had no statistical significance among 4 groups(P>0.05). The change of PCWP was 0.0 mm Hg in placebo group,-3.2 mm Hg in low-dose milrinone group,-3.3 mm Hg in mid-dose milrinone group and-4.7 mm Hg in high-dose milrinone group after treatment. PCWP decreased significantly in all milrinone groups compared with placebo group(all P<0.05) showing a doseindependence. The systolic blood pressure increased significantly in mid-dose milrinone group and high-dose milrinone group, and was higher in high-dose milrinone group than that in mid-dose milrinone group(all P<0.05). The heart rate decreased in all milrinone groups compared with placebo group(all P<0.05) showing a doseindependence. CI increased in high-dose milrinone group compared with placebo group(P<0.05) and LVESV was significantly higher in mid-dose milrinone group than that in placebo group(P=0.03). The mean changes of CI and LVESV had no statistical difference among low-dose milrinone group, high-dose milrinone group and placebo group(P>0.05). The decrease of LVEDV was significantly higher in high-dose milrinone group than that in placebo group(P=0.02), while mean change of LVEDV had no statistical difference among low-dose milrinone group, middose milrinone group and placebo group after treatment. Conclusion The high-dose milrinone can improve PCWP, promote systolic blood pressure and reduce heart rate in AHFS patients.更多还原