Upadya Shrikanth, Lee Forrester A, Saldarriaga Clara, Verma Sumit, Sedrakyan Artyom, Nystrom Karin, Katz Stuart D
Yale University School of Medicine, Department of Internal Medicine, New Haven, Connecticut 06510, USA.
J Heart Lung Transplant. 2004 Apr;23(4):466-72. doi: 10.1016/S1053-2498(03)00203-1.
The clinical use of positive inotropic therapy at home in patients awaiting cardiac transplantation has not been reported since United Network for Organ Sharing (UNOS) regulations were changed to allow home infusions in Status 1B patients.
We observed 21 consecutive patients with UNOS 1B status during positive inotropic therapy at home. We used hemodynamic monitoring at the initiation of therapy to optimize dosing. We selected for home therapy patients with stable clinical status and improved functional capacity during inotropic treatment. Implantable cardioverter defibrillators were placed in all but 1 patient before discharge.
Initial positive inotropic therapy included dobutamine in 12 patients (mean dose, 4.5 mcg/kg/min; range, 2.5-7.5 mcg/kg/min), milrinone in 8 patients (mean dose, 0.44 mcg/kg/min; range, 0.375-0.55 mcg/kg/min), and dopamine at a dose of 3 mcg/kg/min in 1 patient. Patients had improved functional capacity (New York Heart Association Class 3.7 +/- 0.1 to 2.4 +/- 0.2, p < 0.01), improved renal function (serum creatinine, 1.5 +/- 0.1 to 1.3 +/- 0.1, p < 0.01), improved resting hemodynamics, and decreased number of hospitalizations during positive inotropic infusion therapy when compared with pre-treatment baseline. Implantable cardioverter defibrillator discharges were infrequent (0.19 per 100 patient days of follow-up). Actuarial survival to transplantation at 6 and 12 months was 84%.
Continuous positive inotropic therapy at home was safe and was associated with decreased health care costs in selected patients awaiting cardiac transplantation.
自从器官共享联合网络（UNOS）的规定发生变化，允许对1B级患者进行家庭输液以来，尚未有在家中对等待心脏移植的患者使用正性肌力药物治疗的临床报道。
我们观察了21例连续处于UNOS 1B级状态且正在接受家庭正性肌力药物治疗的患者。在治疗开始时，我们使用血流动力学监测来优化给药剂量。我们选择临床状态稳定且在正性肌力治疗期间功能能力有所改善的患者进行家庭治疗。除1例患者外，所有患者在出院前均植入了植入式心脏复律除颤器。
初始正性肌力药物治疗中，12例患者使用多巴酚丁胺（平均剂量，4.5微克/千克/分钟；范围，2.5 - 7.5微克/千克/分钟），8例患者使用米力农（平均剂量，0.44微克/千克/分钟；范围，0.375 - 0.55微克/千克/分钟），1例患者使用多巴胺，剂量为3微克/千克/分钟。与治疗前基线相比，患者的功能能力有所改善（纽约心脏协会分级从3.7±0.1改善至2.4±0.2，p<0.01），肾功能改善（血清肌酐从1.5±0.1降至1.3±0.1，p<0.01），静息血流动力学改善，且在正性肌力药物输注治疗期间住院次数减少。植入式心脏复律除颤器放电不频繁（每100患者日随访0.19次）。6个月和12个月时移植的预期生存率为84%。
对选定的等待心脏移植的患者进行家庭持续正性肌力药物治疗是安全的，且与医疗费用降低相关。
