Nanas J N, Kontoyannis D A, Alexopoulos G P, Anastasiou-Nana M I, Tsagalou E P, Stamatelopoulos S F, Moulopoulos S D
University of Athens School of Medicine, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece.
Chest. 2001 Apr;119(4):1173-8. doi: 10.1378/chest.119.4.1173.
To evaluate the effects of long-term intermittent dobutamine infusion (IDI) with concomitant administration of low-dose amiodarone in patients with congestive heart failure (CHF) refractory to standard medical treatment.
Prospective, interventional clinical trial.
Inpatient and outpatient heart failure clinic in a university teaching hospital.
Twenty-two patients with CHF refractory to standard treatment who could be weaned from dobutamine therapy after an initial 72-h infusion were included in this study. The first 11 patients (group 1) were treated with IDI, 10 micromin, as needed (mean, once every 16 days, lasting for 12 to 48 h); the next 11 patients (group 2) received oral amiodarone, 400 mg/d, and IDI, 10 microg/kg/min, for 8 h every 7 days.
There were no differences in baseline clinical, hemodynamic, and five biochemical characteristics between the two groups. The left ventricular ejection fraction was 13.5 +/- 4.5% in group 1 vs 15.5 +/- 4.9% in group 2 (mean +/- SD; p = 0.451); mean pulmonary capillary wedge pressure was 31.3 +/- 4.4 mm Hg vs 29.4 +/- 3.3 mm Hg (p = 0.316); serum creatinine was 1.9 +/- 0.4 mg/dL vs 1.6 +/- 0.5 mg/dL (p = 0.19); and serum Na was 139.6 +/- 6.2 mEq/L vs 138.4 +/- 3.1 mEq/L (p = 0.569). At 12 months of follow-up, 1 of 11 patients (9%) was alive in group 1 vs 6 of 11 patients (55%) in group 2 (p = 0.011). Furthermore, in group 2, the functional status improved significantly within the first 3 months of treatment, from New York Heart Association functional class IV to 2.63 +/- 0.5 (p = 0.0001).
Long-term IDI in conjunction with amiodarone, added to conventional drugs, improved clinical status and survival of patients with severe CHF.
评估长期间歇性静脉输注多巴酚丁胺（IDI）并联合小剂量胺碘酮对标准药物治疗无效的充血性心力衰竭（CHF）患者的影响。
前瞻性干预性临床试验。
一所大学教学医院的住院及门诊心力衰竭诊所。
本研究纳入了22例对标准治疗无效的CHF患者，这些患者在初始72小时输注后可停用多巴酚丁胺治疗。前11例患者（第1组）根据需要接受IDI治疗，剂量为10微克/分钟（平均每16天1次，持续12至48小时）；接下来的11例患者（第2组）接受口服胺碘酮治疗，剂量为400毫克/天，并接受IDI治疗，剂量为10微克/千克/分钟，每7天持续8小时。
两组患者的基线临床、血流动力学及五项生化特征无差异。第1组的左心室射血分数为13.5±4.5%，第2组为15.5±4.9%（均值±标准差；p = 0.451）；平均肺毛细血管楔压分别为31.3±4.4毫米汞柱和29.4±3.3毫米汞柱（p = 0.316）；血清肌酐分别为1.9±0.4毫克/分升和1.6±0.5毫克/分升（p = 0.19）；血清钠分别为139.6±6.2毫当量/升和138.4±3.1毫当量/升（p = 0.569）。在随访12个月时，第1组11例患者中有1例（9%）存活，第2组11例患者中有6例（55%）存活（p = 0.011）。此外，在第2组中，治疗的前3个月内功能状态显著改善，从纽约心脏协会心功能IV级改善至2.63±0.5（p = 0.0001）。
在常规药物基础上加用长期IDI联合胺碘酮可改善重度CHF患者的临床状况及生存率。
