左西孟旦和肾上腺素对心脏术后低心排综合征治疗作用的比较

目的比较左西孟旦和肾上腺素对心脏术后低心排综合征（LCOS）的作用。方法将48例心脏术后LCOS患者随机分为两组,左西孟旦组（A组,n＝23）按0.05～0.2μg/（kg·min）持续24h,肾上腺素组（B组,n＝25）按0.01～0.04μg/（kg·min）持续1周,维持平均动脉压≥65mmHg。监测心率、平均动脉压、肺毛细血管楔压、中心静脉压、心输出量、心指数、全身血管阻力;用心脏超声分别评价用药前和用药后3和7d的心功能;监测用药前和用药后24和48h的血乳酸值、血肌酐、尿素氮、尿量。观察术后并发症及预后情况。结果两种药物均能显著增加心输出量和心指数（P＜0.05）。A组用药后各时间点全身血管阻力均较B组明显下降（P＜0.05）,且均较用药前明显下降（P＜0.05）。A组用药后24,48h平均动脉压与用药前相比均有显著下降（P＜0.05）。心脏超声结果显示两种药均能改善心功能（P＜0.05）。用药后血乳酸值均显著降低（P＜0.05）。A组用药后48h,尿素氮、血肌酐及尿量均较用药前变化显著（P＜0.05）,且该时间点尿素氮较B组显著降低（P＜0.05）。与B组相比,A组房颤发生率显著减少（P＜0.05）,术后并发症也有减少的趋势。结论两种药物均能明显提高心脏术后LCOS患者血流动力学及心功能指标,改善组织灌注,而左西孟旦对患者肾功能更有益。     

加巴喷丁、氨酚羟考酮联合马来酸氟吡汀在缓解老年带状疱疹患者后遗神经疼痛中的作用

目的探讨加巴喷丁、氨酚羟考酮联合马来酸氟吡汀治疗老年带状疱疹后遗神经疼痛的临床疗效。方法选取68例老年带状疱疹后遗神经疼痛患者,随机数字表法分为观察组和对照组各34例。对照组采用加巴喷丁联合氨酚羟考酮治疗,观察组采用加巴喷丁、氨酚羟考酮联合马来酸氟吡汀治疗。对比两组临床疗效及治疗前后视觉模拟评分法(VAS)评分和疼痛简明记录量表的评估结果。结果观察组总有效率显著高于对照组(P0. 05);两组治疗后VAS评分均显著低于治疗前(均P0. 05);观察组治疗7、15、30 d VAS评分均显著低于对照组(均P0. 05);观察组治疗7、15、30 d各维度的评估结果均显著低于治疗前(均P0. 05);且治疗15 d饮食和睡眠维度,治疗30 d各维度的评估结果均显著低于对照组(均P0. 05)。结论加巴喷丁、氨酚羟考酮联合马来酸氟吡汀可显著改善老年带状疱疹患者后遗神经痛的临床症状,提高患者的生活质量,且具有良好的安全性。     

氨吡酮对COPD患者最大口腔压的影响

用氨吡酮治疗慢性肺心病患者３０例，治疗前后测其最大口腔压，结果表明：用氨吡酮治疗后，肺心患者的最大口腔压有显著（Ｐ〈０．００１），提示氨吡酮能有效提高呼吸肌肌力而改善呼吸功能。     

二甲双胍、吡格列酮对初诊糖代谢异常伴腹型肥胖患者血脂及尿酸的影响

目的 探讨二甲双胍、吡格列酮对初诊糖代谢异常伴腹型肥胖患者血脂及尿酸的影响.方法 选择初诊糖代谢异常伴腹型肥胖患者36例,随机分为二甲双胍组20例(1 500 mg/d)、吡格列酮组16例(30 mg/d).治疗3个月后,观察两组治疗前后血糖、胰岛素、糖化血红蛋白、血脂和血尿酸等指标变化.结果 二甲双胍组治疗后LDL-C较治疗前明显下降(P＜0.05);吡格列酮组治疗后TG、血尿酸水平较治疗前明显下降(P均＜0.05).结论 在治疗剂量下,二甲双胍主要降低LDL-C水平,吡格列酮主要降低TG、血尿酸水平.     

婴幼儿心脏不停跳和停跳心内直视手术的临床对比

目的:比较浅低温心脏不停跳和中低温停跳技术,在婴幼儿心内直视手术的应用。方法:分析56例3岁以下心脏手术患者,将其分为停跳组(组Ⅰ)26例和不停跳组(组Ⅱ)30例。比较2组患者的体外循环(CPB)时间、手术时间、术后呼吸机辅助时间、术后低心排出量综合征(低心排)发生率等指标。结果:不停跳组患者的体外循环时间和手术时间均较停跳组短(P<0.01),并且术后呼吸机辅助时间、术后住院时间较停跳组短(P<0.05);不停跳组患者术后低心排发生率和严重心律失常发生率,均较停跳组低(P<0.05)。结论:表明浅低温体外循环心脏不停跳,可作为一项安全、有效的技术应用于婴幼儿先天性心脏畸形的矫治。     

氯吡格雷对ACS患者血清VCAM-1、ICAM-1及hs-CRP的影响

急性冠脉综合征患者98例,随机分为阿司匹林组和阿司匹林加氯吡格雷组各49例.分别在用药前,用药后7、30 d抽取空腹静脉血,检测血清血管内皮细胞黏附分子(VCAM-1)、细胞间黏附分子(ICAM-1)及高敏C反应蛋白(hs-CRP)水平,并观察用药30 d两组主要不良心脏事件的发生情况.结果两组用药后7、30 d血清VCAM-1、ICAM-1及hs-CRP浓度均有降低(P<0.05),阿司匹林加氯吡格雷组血清VCAM-1、ICAM-1及hs-CRP浓度降低较阿司匹林组显著(P<0.05),且主要不良心脏事件发生率明显降低(P<0.05).认为氯吡格雷在抗血小板同时,可抑制动脉粥样硬化的炎症反应,进而减少了临床心脏事件的发生.     

多普勒超声法测氨吡酮治疗前后的左心室功能变化

本文报告应用二维，脉冲多普勒，Ｍ型超声心动图观察５０例慢性左心衰病人氨吡酮治疗前，后的左心功能变化。肯定了氨吡酮正性肌力的强心作用。治疗前１０例患者的超声检查结果与漂浮导管法进行了比较，证实多普勒超声在心尖五腔观主动脉瓣环水平测量的心搏量及心输出量与其相关最佳。     

亚治疗剂量低分子肝素作为机械瓣膜患者再次外科手术的桥接抗凝治疗效果

目的 机械心脏瓣膜（MHV）患者接受再次手术时，需要中断华法林的抗凝治疗，往往需要桥接低分子肝素（LMWH）进行抗凝。本研究的目的是评估MHV患者再次接受择期手术（心脏手术和非心脏手术）桥接亚治疗剂量的LMWH是否是一种安全有效的方法。 方法 观察我院在2013年1月1日到2018年1月1日收治的需再次择期手术的机械瓣膜置换术后患者（瓣膜置换组，n = 47），瓣膜置换组纳入标准是围手术期桥接抗凝的机械瓣置换的患者,并经心外科医生制定桥接抗凝方案患者（机械瓣主动脉瓣置换术后患者14例，机械瓣二尖瓣/双瓣置换术后患者33例），以同期行相同手术的患者（未做过瓣膜置换术）为对照组（n = 47），主要观察指标是住院病死率、术中出血量、桥接后30 d内血栓栓塞事件或主要出血事件的发生率。 结果 瓣膜置换组术中出血量及术后第一个24 h出血量较对照显著增多（P < 0.05），瓣膜置换组1例死亡（2%），死亡原因为低心排，并出现1例（2%）出血事件，两组均未发生栓塞事件，但与对照组相比两组病死率、栓塞事件和出血事件发生率均无显著性差异。 结论 机械瓣膜置换术后患者在进行择期外科手术期间采用亚治疗剂量LMWH进行桥接抗凝术中出血量增多，但严重并发症发生率无显著增加，此结论尚需进一步验证。     

多普勒超声法测氨吡酮治疗前后在左心室功能变化

本文报告应用二维，脉冲多普勒，Ｍ型超声心动图观察５０例慢性左心衰病人氨吡酮治疗前，后的左心功能变化。肯定了氨吡酮正性肌力的强心作用。治疗前１０例患者的超声检查与漂导法进行了比较，证实多普勒超声在心尖五腔观主动脉瓣环水平测量的心搏量及心输出量与其相关最佳。     

大剂量氨甲苯酸用于减少心脏瓣膜替换术出血的研究

目的：为了观察大剂量氨甲苯酸（ｐ－ａｍｉｎｏｍｅｔｈｙｌｂｅｎｚｏｉｃａｃｉｄ）在心脏手术后的止血作用。方法：６０例心脏瓣膜替换术患者按随机双盲法分为两组，每组３０例。治疗组在手术开始前静脉注射氨甲苯酸４０ｍｇ／ｋｇ，对照组给予等量生理盐水。记录每例在关胸期间、术后６小时和２４小时胸部及纵隔失血量并进行组间比较。结果：治疗组和对照组术后６小时胸部失血量分别为２９８±１１４ｍｌ和４２４±１９５ｍｌ（Ｐ＜０．０５）；术后２４小时两组胸部失血量分别为４８４±１６４ｍｌ和６１７±２４０ｍｌ（Ｐ＜０．０５），均有显著差异。结论：术前预防性应用大剂量氨甲苯酸可使心脏瓣膜替换术后胸部失血量明显减少。     

Amrinone in the treatment of chronic cardiac failure

The efficacy and safety of oral amrinone were examined in 17 patients with moderately severe to severe heart failure that was refractory to standard medical therapy and vasodilators. The short-term and 28 week response to open amrinone therapy was assessed first, followed by a placebo-controlled, double-blind withdrawal study of two 13 week stages in nine patients. Rest and exercise ventricular function were determined before and after 32 hours of amrinone; aerobic capacity was serially assessed. After 2 hours, 1.64 mg/kg amrinone produced a 40% (p less than 0.001) increase in cardiac output and a 32% (p less than 0.02) decrease in pulmonary wedge pressure without altering heart rate or blood pressure. The exercise cardiac index-wedge pressure curve obtained 32 hours after the first oral dose was significantly shifted (p less than 0.05) above control values. A sustained improvement in maximal oxygen uptake was noted during long-term open amrinone therapy. Subsequently, seven of the patients randomized to placebo therapy had a significant deterioration of symptoms or exercise tolerance, or both. After 4 weeks of readministration of amrinone, clinical stability was once again established and exercise tolerance was improved by Weeks 8 to 16. Adverse effects of thrombocytopenia (one patient) and hepatic dysfunction (one patient) attributable to amrinone were observed. It is concluded that amrinone is effective in the long-term treatment of chronic cardiac failure.     

Preliminary results with amrinone in perioperative low cardiac output syndrome

The hemodynamic parameters of 24 cardiosurgical patients with low cardiac output syndrome (LCOS) after weaning from bypass were evaluated retrospectively. These patients were additionally treated with amrinone if the conventional therapy with catecholamines and vasodilators did not reach satisfying hemodynamic results. 14 patients underwent aorto-coronary bypass surgery, 10 patients underwent valve repair. Their disability by NYHA class was III and IV. One third of these patients died between the first and the fifth day postoperatively. Hemodynamic assessment was performed after weaning from bypass and after the start of amrinone therapy and was continued the first 24 hours in the intensive care unit, as long as the patients were dependent on amrinone. The platelet count was determined every eight hours after surgery. Under the supplementary therapy with amrinone we found an increase of the arterial pressure and cardiac index and decrease of heart rate and total peripheral resistance. These salutary hemodynamic changes could be sustained in the postoperative period. The platelet count dropped from nearly 100,000/mm3 in mean (first measurement post-op.) to 58,000 in mean (the lowest value during 48 hours on intensive care). 2 patients showed a decrease to 11,000 and 15,000/mm3 with petechial bleedings. These findings indicate that on the one hand amrinone seems to be a promising drug in cases of severe LCOS when conventional therapy fails, but on the other hand a marked decrease of the platelets can occur. Therefore a frequent control of platelet count has to be performed when using amrinone.     

不停跳与体外循环下冠状动脉旁路移植术对患者心肌和肾功能影响的对比研究

目的 探讨不停跳下行冠状动脉旁路移植术(CABG)与体外循环下行CABG对患者心肌和肾功能影响.方法 将2015年1月至2018年1月间陕西省汉中市中心医院收治的100例冠心病患者随机分为不停跳组(50例)和体外循环组(50例)分别在不停跳下行冠状动脉旁路移植术(OPCABG)与体外循环下冠状动脉旁路移植术(CCABG...     

鲁南力康(米力农)治疗充血性心力衰竭的疗效与安全性

本研究用米力农治疗75例心力衰竭患者并与20例氨力农治疗者作对照,结果米力农治疗经7天(一疗程)治疗后症状明显改善,用99~mTC核素所测左室喷血分数(LVEF%)明显改善,由治疗前的36.1±15.9%升高至41.76±18.7%(P<0.02),用超声心动图所测心搏量(SV)、心排量(CO)、心脏指数(CI)亦有明显改善,SV(ml/beat)由治疗前的90.36±38.69上升至103.1±38.69,CO(L/min)由治疗前的5.78±2.83上升至7.35±3.88,CI(L/mm/m~2)由3.75±2.23上升至4.72±2.27,P值均<0.001,用Swan—Ganz球囊导管所测血流动力学效应,示CI和SVI(每搏容量指数)显著增加,PCWP(肺毛细血管契压)、PAP(肺动脉压力)、SVR(外周血管阻力)显著下降,P值均<0.05,血压和心率无明显改变(P>0.05),总有效率为90%,对3例已有洋地黄中毒但心衰仍未控制者亦取得明显效果.     

Comparative actions of hydralazine, nifedipine and amrinone in primary pulmonary hypertension

The effects of 3 types of vasoactive agents, hydralazine, nifedipine and amrinone, were evaluated in 7 patients with primary pulmonary hypertension (PPH). Hemodynamic values were measured before and after drug administration in every patient. All drugs increased cardiac output and reduced both systemic and pulmonary resistance in the patients studied. Only nifedipine significantly reduced pulmonary artery (PA) pressure (6 +/- 5 mm Hg). In addition, it decreased pulmonary resistance to a greater degree than systemic resistance in 2 of the 7 patients, suggesting that nifedipine can cause selective pulmonary vasodilation in some patients. Hydralazine appeared to increase cardiac output and stroke volume by reducing systemic resistance. There was no evidence of direct pulmonary vasodilating effects; it decreased systemic resistance more than pulmonary resistance in every case. The increase in cardiac output from amrinone was secondary to a decrease in systemic arterial pressure with reflex tachycardia; stroke volume was unchanged. Amrinone had little pulmonary effect in all but 1 patient, in whom it substantially reduced PA pressure and pulmonary resistance. The mechanism of action of these 3 drugs in PPH differs. Nifedipine holds the most promise as an effective pulmonary vasodilator. A study of the effects of long-term administration of nifedipine in PPH is warranted.     

Comparison of the effects of amrinone and sodium nitroprusside on haemodynamics, contractility, and myocardial metabolism in patients with cardiac failure due to coronary artery disease and dilated cardiomyopathy.

The effects of intravenous amrinone and sodium nitroprusside on haemodynamic indices, left ventricular contractility, and myocardial metabolism were compared in patients with cardiac failure. All patients received one dose of each drug and some received serial doses. Eight patients had dilated cardiomyopathy and six coronary artery disease, but the responses to the two drugs were independent of the aetiology of cardiac failure. Both drugs lowered left ventricular end diastolic pressure and aortocoronary sinus oxygen difference and increased cardiac index and left ventricular efficiency; these effects were dose related. Although the effects of the drugs on peripheral blood substrate concentrations were different, those on myocardial substrate metabolism were identical. Pressure derived indices of contractility in each group of patients were unaltered by either drug. After amrinone administration increases in cardiac index were related to plasma amrinone concentration, but alterations in contractility were not. In four individual patients increases in contractility were associated with alterations in plasma metabolite concentrations, which suggested that catecholamine release had occurred. For the groups of patients as a whole, however, amrinone had effects which did not differ significantly from those of the pure vasodilator, nitroprusside. There was no evidence that amrinone had a direct positive inotropic effect since no dose related changes in indices of contractile function could be established.     

Comparison of the effects of amrinone and sodium nitroprusside on haemodynamics, contractility, and myocardial metabolism in patients with cardiac failure due to coronary artery disease and dilated cardiomyopathy

The effects of intravenous amrinone and sodium nitroprusside on haemodynamic indices, left ventricular contractility, and myocardial metabolism were compared in patients with cardiac failure. All patients received one dose of each drug and some received serial doses. Eight patients had dilated cardiomyopathy and six coronary artery disease, but the responses to the two drugs were independent of the aetiology of cardiac failure. Both drugs lowered left ventricular end diastolic pressure and aortocoronary sinus oxygen difference and increased cardiac index and left ventricular efficiency; these effects were dose related. Although the effects of the drugs on peripheral blood substrate concentrations were different, those on myocardial substrate metabolism were identical. Pressure derived indices of contractility in each group of patients were unaltered by either drug. After amrinone administration increases in cardiac index were related to plasma amrinone concentration, but alterations in contractility were not. In four individual patients increases in contractility were associated with alterations in plasma metabolite concentrations, which suggested that catecholamine release had occurred. For the groups of patients as a whole, however, amrinone had effects which did not differ significantly from those of the pure vasodilator, nitroprusside. There was no evidence that amrinone had a direct positive inotropic effect since no dose related changes in indices of contractile function could be established.     

Effects of preemptive therapy with milrinone or amrinone on perioperative platelet function and haemostasis in patients undergoing coronary bypass grafting

Preemptive therapy with a phosphodiesterase III inhibitor preserves cardiac function and oxygen transport after cardiac surgery, and its safety on platelet function and haemostasis must be verified. We examined the effects of preemptively administered milrinone or amrinone on platelet function and haemostasis. In 45 cardiac surgery patients, we randomly administered milrinone 50 microg/kg plus 0.5 microg/kg/min for 10 hours, amrinone 1.5 mg/kg plus 10 microg/kg/min infusion for 10 hours, or placebo at release of aortic cross-clamp. Whole blood platelet aggregation, haematological values, and postoperative chest drainage were examined. Three patients in the placebo, 1 patient in the amrinone, and 2 patients in the milrinone groups received allogenic blood transfusion (654 +/- 365 ml) intraoperatively, but no patient postoperatively. The mean platelet counts 3 days postoperative in the milrinone and amrinone groups did not significantly differ from the placebo group (10.9 +/- 3.3 and 12.1 +/- 3.8, vs. 12.1 +/- 3.4x10(4) per cubic millimeter, respectively), and chest-tube drainage in the first 24 hours did not significantly differ (450 +/- 156 and 391 +/- 184, vs. 448 +/- 140 ml, respectively). Although there were changes in platelet aggregation consequent to surgery there was no significant differences in platelet aggregation or other haematological values among the three groups. Preemptive therapy of milrinone or amrinone does not deteriorate perioperative platelet function and haemostasis beyond surgical interventions.     

单向活瓣补片在合并重度肺动脉高压先心病治疗中的应用

为探讨合并重度肺动脉高压先心病的有效治疗方法 ,采用单向活瓣补片对 30例本病患者进行手术治疗。术后 5例肺动脉压力下降明显 ,未出现跨单向活瓣补片分流 ;余 2 5例 72小时内出现分流 ,其中 1例术后 72小时死于低心排综合征 ,1例 4周死于右心衰竭 ;2 8例康复出院。对术后出现分流的 2 0例随访 3～ 4 1个月 ,其中术后 3个月仍出现跨单向活瓣补片分流 6例 ,右向左分流 3例 ,双向分流 3例 ;半年以上仍存在单向活瓣补片分流 4例 ,其中 3例肺动脉收缩压 (PP) /主动脉收缩压 (PS) >0 .75 ,2例右向左分流 ,1例双向分流 ;另 1例 PP/ PS降至 0 .4 5 ,存在 3mm跨单向活瓣补片左向右分流。 18例自觉症状及生活质量较术前改善明显。表明对于合并重度肺动脉高压的先心病应用单向活瓣补片行手术修补 ,允许右向左、阻止左向右分流 ,术后右心压力高于左心者右心血流可通过单向活瓣补片活瓣孔分流到左心系统 ,为右心起到泄洪减压作用 ,同时以可以耐受的体循环血氧饱和度降低为代价增加左心系血容量 ,保证左心排出量 ,有利于保持体肺循环相对平衡 ,使患者度过术后危险期 ,减少围术期死亡     

Effects of amrinone on cardiac index, venous oxygen saturation and venous admixture in patients recovering from cardiac surgery

The hemodynamic and oxygen transport effects of low-dose (0.75 mg/kg loading dose + 10 micrograms/kg/min infusion, n = 12) and high-dose (2.25 mg/kg loading dose + 20 micrograms/kg/min infusion, n = 12) amrinone were evaluated in extubated patients 24 h after CABG. At both doses, amrinone significantly (p less than 0.05) increased HR, but decreased mean arterial, mean pulmonary artery, central venous and pulmonary artery occlusion pressures. High-dose amrinone significantly decreased systemic vascular resistance. Arterial oxygen saturation decreased significantly following both low- (97.8 +/- 0.4 to 95.6 +/- 0.9 percent) and high- (98.8 +/- 3.4 to 93.9 +/- 1.2 percent) dose amrinone. Pulmonary shunt increased significantly following low-dose amrinone and markedly increased Qs/Qt after high-dose amrinone. Although amrinone significantly increased cardiac index in a dose-dependent fashion (low:3.0 +/- 0.2 to 3.3 +/- 0.3 L/min/m2; high:2.7 +/- 0.2 to 3.4 +/- 0.2 L/min/m2), mixed venous oxygen saturation did not change. Thus, mixed venous oxygen saturation may not predict the hemodynamic response to amrinone infusion in postoperative surgical patients.