CAJ | 학술논문

目的评价小剂量米力农治疗难治性心力衰竭合并肾功能不全的疗效和安全性.方法将42例难治性心力衰竭合并肾功能不全患者按随机数字表法分为治疗组和对照组,对照组21例,给予常规强心、利尿、扩血管治疗,治疗组21例,在常规治疗基础上加用米力农0.375μ g/(kg·min),总剂量10mg/d,两组均连续治疗7d.观察治疗前后症状、体征、血压、心率、心功能指标、肾功能指标等变化.结果治疗组临床总有效率为85.7%(18/21),明显高于对照组的57.1%(12/21),差异有统计学意义(P＜0.05).两组治疗后7 d,心率、收缩压、舒张压、每搏输出量、心输出量、左室射血分数均较治疗前明显改善,但治疗组改善更显著[治疗组与对照组治疗后上述指标比较分别为(79.3±12.4)次/min比(85.4±10.2)次/min、(107.6±15.4)mm Hg(1 mm Hg=0.133 kPa)比(119.1±13.5)mm Hg、(60.8±9.4)mm Hg比(65.8±8.5)mm Hg、(66.3±10.2)ml比(61.2±9.3)ml、(5.3±0.6)L/min比(4.8±0.9)L/min、(56.6±8.4)%比(48.9±7.3)%,P值均＜0.05].两组治疗前后肾功能指标比较差异无统计学意义(P＞0.05).结论小剂量米力农能有效改善难治性心力衰竭合并肾功能不全患者的心功能,且肾脏安全性良好.
목적 평개소제량미력농치료난치성심력쇠갈합병신공능불전적료효화안전성.방법 장42례난치성심력쇠갈합병신공능불전환자안수궤수자표법분위치료조화대조조,대조조21례,급여상규강심、이뇨、확혈관치료,치료조21례,재상규치료기출상가용미력농0.375μ g/(kg·min),총제량10mg/d,량조균련속치료7d.관찰치료전후증상、체정、혈압、심솔、심공능지표、신공능지표등변화.결과 치료조림상총유효솔위85.7%(18/21),명현고우대조조적57.1%(12/21),차이유통계학의의(P＜0.05).량조치료후7 d,심솔、수축압、서장압、매박수출량、심수출량、좌실사혈분수균교치료전명현개선,단치료조개선경현저[치료조여대조조치료후상술지표비교분별위(79.3±12.4)차/min비(85.4±10.2)차/min、(107.6±15.4)mm Hg(1 mm Hg=0.133 kPa)비(119.1±13.5)mm Hg、(60.8±9.4)mm Hg비(65.8±8.5)mm Hg、(66.3±10.2)ml비(61.2±9.3)ml、(5.3±0.6)L/min비(4.8±0.9)L/min、(56.6±8.4)%비(48.9±7.3)%,P치균＜0.05].량조치료전후신공능지표비교차이무통계학의의(P＞0.05).결론 소제량미력농능유효개선난치성심력쇠갈합병신공능불전환자적심공능,차신장안전성량호.
Objective To observe the effect and safety of low dose milrinone used in patients suffering from refractory heart failure and renal dysfunction. Methods Forty-two patients with refractory heart failure and renal dysfunction were divided into treatment group(21 cases ) and control group(21 cases )by random digits table. All the patients accepted a therapy of cardiac booster, diuretics and vasodilators, and treatment group also accepted the therapy of milrinone [0.375 μ g/( kg· min), 10 mg/d, for 7 days]. And then the symptom, signs, blood pressure, heart rate, heart function and renal function before and after the treatment were observed. Results The total effective rate in treatment group was 85.7%( 18/21 ) ,significantly higher than that in control group [57.1% (12/21)] (P ＜0.05＝. After treatment,the heart rate,systolic blood pressure,diastolic blood pressure,stroke volume,cardiac output and left ventricular ejection fraction in treatment group and control group improved significantly than those before treatment, and these index improved better in treatment group [(79.3 ± 12.4) beats/min vs. (85.4 ± 10.2) beats/min, ( 107.6 ± 15.4)mm Hg ( 1 mm Hg = 0.133 kPa) vs.( 119.1 ± 13.5 ) mm Hg, (60.8 ± 9.4) mm Hg vs. (65.8 ± 8.5 ) mm Hg,(66.3 ± 10.2 ) ml vs. (61.2 ± 9.3 ) ml, (5.3 ± 0.6 ) L/min vs. (4.8 ± 0.9) L/min, (56.6 ± 8.4 )% vs. (48.9 ±7.3)% ,P ＜ 0.05＝. In two groups,there were no statistical difference in renal function. Conclusions Low dose of milrinone can improve the heart function of the patients with refractory heart failure and renal dysfunction and has good renal safety.