摘要
目的：探讨米力农和多巴酚丁胺治疗急性心肌梗死（AMI）后急性心力衰竭的临床疗效及安全性。方法：选择AMI后出现心力衰竭患者180例,心功能均为KillipⅢ~Ⅳ级,随机分为基础治疗组、多巴酚丁胺组与米力农组,每组各60例。多巴酚丁胺组及米力农组均在控制心力衰竭、治疗AMI的基础治疗上加用多巴酚丁胺或米力农治疗;多巴酚丁胺组给予多巴酚丁胺的起始剂量2.5μg/（kg·min）,随后根据血压情况上调多巴酚丁胺剂量,最大剂量用至10μg/（kg·min）。米力农组给予米力农负荷量50μg/kg,10 min缓慢静脉滴注,以后0.5μg/（kg·min）静脉持续泵入,5 d为1个疗程。评估患者治疗前、后心功能指标变化。结果：治疗后3组患者脑钠肽（BNP）、左室射血分数（LVEF）、左室舒张末期内径（LVEDD）及心排血量（CO）等指标较治疗前均有明显改善（P〈0.05或P〈0.01）,多巴酚丁胺、米力农对BNP、LVEDD、LVEF和CO的影响较基础治疗明显,而米力农组治疗后患者BNP、LVEF、HR水平的变化较多巴酚丁胺组明显（P〈0.05或P〈0.01）,治疗后3组SBP、DBP比较差异无统计学意义。治疗过程中未见明显的不良事件发生。结论：米力农和多巴酚丁胺较基础治疗更能安全有效地改善心功能,且短期、小剂量持续应用米力农治疗AMI后心力衰竭更为有效。
Objective： To explore the efficacy and safety of milrinone and dobutamine in treatment of patients with acute heart failure after acute myocardial infarction（ AMI）. Methods： A total of 180 patients with heart failure after AMI（ KillipⅢ-Ⅳ） were randomly divided into control group,dobutamine group and milrinone group,60 cases for each group. The control group received conventional therapy while dobutamine group and milrinone group received intravenous injection of dobutamine or milrinone respectively on basis of conventional therapy. Dobutamine was given 2. 5 μg /（ kg·min） initially,then the dose was boosted gradually according to the blood pressure with maximum to 10μg /（ kg·min）. Milrinone was given with an initial 50 μg /（ kg·min） bolus dose in ten minutes and followed by 0. 5 μg /（ kg·min） through micro pump intravenous continuously for 5 days as a course. The changes of heart function parameters were detected before and after treatment. Results： As compared with those before treatment,the brain natriuretic peptide（ BNP）,left ventricular ejection fraction（ LVEF）,left ventricular end-diastolic diameter（ LVEDD） and cardiac output（ CO） in three groups were improved significantly after treatment（ P〈0. 05 or P〈0. 01）. BNP、LVEDD、LVEF and CO in dobutamine group and milrinone group were markedly improved compared with those in control group after treatment. BNP,LVEF and HR in milrinone group were obviously improved as compared with those in dobutamine group after treatment（ P〈0. 05 or P〈0. 01）. The clinical investigation revealed that systolic blood pressure（ SBP） and diastolic blood pressure（ DBP） in three groups showed no statistically difference. No serious adverse event was found during the treatment. Conclusions： The administration of milrinone and dobutamine is safe and effective in treatment of patients with acute heart failure after AMI. The short-time,low-dose continuous administration of milrinone is better in improving ca
出处
《内科急危重症杂志》
2015年第3期195-198,共4页
Journal of Critical Care In Internal Medicine
