Cusick D A, Pfeifer P B, Quigg R J
Department of Medicine, Northwestern University Medical School, Chicago, Illinois, USA.
Am J Cardiol. 1998 Nov 1;82(9):1060-5. doi: 10.1016/s0002-9149(98)00557-8.
This study evaluated the efficacy of intravenous milrinone in improving hemodynamics and facilitating the titration of high-dose oral vasodilator therapy to improve clinical status. Fourteen patients (mean age 52 +/- 12 years) with severe heart failure and a left ventricular ejection fraction of 18 +/- 6% underwent right-side heart catheterization and an intravenous milrinone infusion followed by titration of oral vasodilator and diuretic therapy. Milrinone significantly (p <0.05) improved right atrial pressure (12 +/- 5 to 8 +/- 5 mm Hg), pulmonary capillary wedge pressure (23 +/- 7 to 15 +/- 7 mm Hg), cardiac index (1.9 +/- 0.4 to 3.4 +/- 0.5 L/min/m2), systemic vascular resistance (1,809 +/- 526 to 891 +/- 144 dynes/s/cm(-5)), and pulmonary vascular resistance (285 +/- 151 to 163 +/- 68 dynes/s/cm(-5)), which was maintained in 10 patients with titration of high-dose oral vasodilator therapy. Oral angiotensin-converting enzyme inhibitor and diuretic doses were increased 318% and 89%, respectively. Four patients also received hydralazine to optimize hemodynamics. New York Heart Association functional class improved from 3.8 +/- 0.4 to 2.6 +/- 0.6 following therapy. Ten patients who responded to therapy had fewer hospitalized days during the subsequent year compared with the year before treatment (4 +/- 17 vs 17 +/- 15), and no patient died. In contrast, the 3 patients who responded poorly to therapy tended to have more hospitalized days at 12 months compared with pretreatment (31 +/- 11 vs 20 +/- 18; NS); 1 patient died. We conclude that intravenous milrinone followed by optimization of oral medical therapy may be used as a therapeutic trial to identify patients in need of cardiac transplantation.
本研究评估了静脉注射米力农在改善血流动力学以及促进大剂量口服血管扩张剂治疗滴定以改善临床状况方面的疗效。14例严重心力衰竭患者（平均年龄52±12岁），左心室射血分数为18±6%，接受了右侧心导管检查及静脉注射米力农，随后进行口服血管扩张剂和利尿剂治疗的滴定。米力农显著（p<0.05）改善了右心房压力（从12±5降至8±5mmHg）、肺毛细血管楔压（从23±7降至15±7mmHg）、心脏指数（从1.9±0.4升至3.4±0.5L/min/m²）、全身血管阻力（从1809±526降至891±144达因/秒/厘米⁻⁵）以及肺血管阻力（从285±151降至163±68达因/秒/厘米⁻⁵），在10例进行大剂量口服血管扩张剂治疗滴定的患者中这些改善得以维持。口服血管紧张素转换酶抑制剂和利尿剂的剂量分别增加了318%和89%。4例患者还接受了肼屈嗪以优化血流动力学。治疗后纽约心脏协会心功能分级从3.8±0.4改善至2.6±0.6。10例对治疗有反应的患者在随后一年中的住院天数比治疗前一年减少（4±17天对17±15天），且无患者死亡。相比之下，3例对治疗反应不佳的患者在12个月时的住院天数与治疗前相比有增多趋势（31±11天对20±18天；无统计学意义）；1例患者死亡。我们得出结论，静脉注射米力农后优化口服药物治疗可作为一种治疗试验，以识别需要心脏移植的患者。
