目的:探讨长期间断使用左西孟旦治疗治疗终末期心力衰竭的疗效和安全性。方法:应用计算机从Pubmed、Springer、Cochrane图书馆、Elsevier、Wiley、Web of science、CNKI、万方等电子数据库中检索自建库至2017年7月关于重复使用左西孟旦...目的:探讨长期间断使用左西孟旦治疗治疗终末期心力衰竭的疗效和安全性。方法:应用计算机从Pubmed、Springer、Cochrane图书馆、Elsevier、Wiley、Web of science、CNKI、万方等电子数据库中检索自建库至2017年7月关于重复使用左西孟旦治疗终末期心力衰竭的随机对照临床试验。获取数据资料后用RevMan 5.3进行meta分析,研究长期间断使用左西孟旦治疗终末期心力衰竭的疗效和安全性。结果:对纳入的10项随机对照试验(共562例患者)进行meta分析,平均随访周期(7.3±3.7)个月。与对照组比较,长期间断使用左西孟旦的患者(实验组)病死率明显减少[实验组(20/271,7.38%),对照组(44/266,16.54%),OR=0.42,95%CI:0.23～0.45,P=0.004,I^2=0%],左室射血分数(LVEF)显著改善(MD=4.65,95%CI:3.43～5.86,P<0.000 01,I2=0%),且发生药物不良事件未见显著差异[实验组(32/126,25.40%),对照组(18/111,16.21%),OR=1.51,95%CI:0.45～4.98,P=0.5,I^2=44%]。结论:长期间断使用左西孟旦能够降低终末期心力衰竭患者的病死率,改善左室射血功能,且不增加药物不良事件发生率。展开更多
In advanced heart failure(HF), chronic inotropic therapy with intravenous milrinone, a phosphodiesterase Ⅲ inhibitor, is used as a bridge to advanced management that includes transplantation, ventricular assist devic...In advanced heart failure(HF), chronic inotropic therapy with intravenous milrinone, a phosphodiesterase Ⅲ inhibitor, is used as a bridge to advanced management that includes transplantation, ventricular assist device implantation, or palliation. This is especially true when repeated attempts to wean off inotropic support result in symptomatic hypotension, worsened symptoms, and/or progressive organ dysfunction. Unfortunately, patients in this clinical predicament are considered hemodynamically labile and may escape the benefits of guidelinedirected HF therapy. In this scenario, chronic milrinone infusion may be beneficial as a bridge to introduction of evidence based HF therapy. However, this strategy is not well studied, and in general, chronic inotropic infusion is discouraged due to potential cardiotoxicity that accelerates disease progression and proarrhythmic effects that increase sudden death. Alternatively, chronic inotropic support with milrinone infusion is a unique opportunity in advanced HF. This review discusses evidence that long-term intravenous milrinone support may allow introduction of beta blocker(BB) therapy. When used together, milrinone does not attenuate the clinical benefits of BB therapy while BB mitigates cardiotoxic effects of milrinone. In addition, BB therapy decreases the risk of adverse arrhythmias associated with milrinone. We propose that advanced HF patients who are intolerant to BB therapy may benefit from a trial of intravenous milrinone as a bridge to BB initiation. The discussed clinical scenarios demonstrate that concomitant treatment with milrinone infusion and BB therapy does not adversely impact standard HF therapy and may improve left ventricular function and morbidity associated with advanced HF.展开更多
文摘目的:探讨长期间断使用左西孟旦治疗治疗终末期心力衰竭的疗效和安全性。方法:应用计算机从Pubmed、Springer、Cochrane图书馆、Elsevier、Wiley、Web of science、CNKI、万方等电子数据库中检索自建库至2017年7月关于重复使用左西孟旦治疗终末期心力衰竭的随机对照临床试验。获取数据资料后用RevMan 5.3进行meta分析,研究长期间断使用左西孟旦治疗终末期心力衰竭的疗效和安全性。结果:对纳入的10项随机对照试验(共562例患者)进行meta分析,平均随访周期(7.3±3.7)个月。与对照组比较,长期间断使用左西孟旦的患者(实验组)病死率明显减少[实验组(20/271,7.38%),对照组(44/266,16.54%),OR=0.42,95%CI:0.23～0.45,P=0.004,I^2=0%],左室射血分数(LVEF)显著改善(MD=4.65,95%CI:3.43～5.86,P<0.000 01,I2=0%),且发生药物不良事件未见显著差异[实验组(32/126,25.40%),对照组(18/111,16.21%),OR=1.51,95%CI:0.45～4.98,P=0.5,I^2=44%]。结论:长期间断使用左西孟旦能够降低终末期心力衰竭患者的病死率,改善左室射血功能,且不增加药物不良事件发生率。
文摘In advanced heart failure(HF), chronic inotropic therapy with intravenous milrinone, a phosphodiesterase Ⅲ inhibitor, is used as a bridge to advanced management that includes transplantation, ventricular assist device implantation, or palliation. This is especially true when repeated attempts to wean off inotropic support result in symptomatic hypotension, worsened symptoms, and/or progressive organ dysfunction. Unfortunately, patients in this clinical predicament are considered hemodynamically labile and may escape the benefits of guidelinedirected HF therapy. In this scenario, chronic milrinone infusion may be beneficial as a bridge to introduction of evidence based HF therapy. However, this strategy is not well studied, and in general, chronic inotropic infusion is discouraged due to potential cardiotoxicity that accelerates disease progression and proarrhythmic effects that increase sudden death. Alternatively, chronic inotropic support with milrinone infusion is a unique opportunity in advanced HF. This review discusses evidence that long-term intravenous milrinone support may allow introduction of beta blocker(BB) therapy. When used together, milrinone does not attenuate the clinical benefits of BB therapy while BB mitigates cardiotoxic effects of milrinone. In addition, BB therapy decreases the risk of adverse arrhythmias associated with milrinone. We propose that advanced HF patients who are intolerant to BB therapy may benefit from a trial of intravenous milrinone as a bridge to BB initiation. The discussed clinical scenarios demonstrate that concomitant treatment with milrinone infusion and BB therapy does not adversely impact standard HF therapy and may improve left ventricular function and morbidity associated with advanced HF.
