米力农治疗慢性肺心病心衰50例疗效观察

目的：观察米力农对慢性肺心病心衰的疗效。寻求纠正慢性肺心病心 合理用药。方法：50例患者为米力农治疗组，在综合治疗的基础以上米力农2.5mg 5%GS 20ml缓慢静注，再以5mg 5%GS 250ml静滴，每日一次，7天为一疗程。结果：米力农组显效22／50（44％），有效26／50（52％），总有效率96％，明显高于对照组（P＜0．03）。结论：慢性肺心病心衰洋地黄类强心剂不但疗效差，且易致中毒，选择米力农既发挥正性肌力作用，又可扩张血管减轻心脏负荷，疗效肯定安全。     

参麦注射液联合米力农治疗慢性肺心病心力衰竭的疗效观察

目的观察参麦注射液联合米力农治疗慢性肺心病心力衰竭的疗效。方法选择我院收治的慢性肺心病心力衰竭患者78例,随机分为观察组39例和对照组39例,对照组给予常规治疗及乳酸米力农注射液静脉滴注,观察组在对照组基础上再予参麦注射液静脉滴注,两组均治疗20天为1个疗程。结果经治疗1个疗程后,观察组显效16例,有效17例,无效6例,总有效率为84.62%,对照组显效11例,有效16例,无效12例,总有效率为69.23%,观察组疗效明显优于对照组(P0.05)。结论参麦注射液联合米力农治疗慢性肺心病心力衰竭疗效较好,故值得推广。     

慢性肺源性心脏病的临床治疗分析

目的分析米力农联合低分子肝素治疗慢性肺源性心脏病的疗效。方法选取我院2013年1月~2014年12月收治的慢性肺心病患者82例作为研究对象,随机将其分为治疗组和对照组,各41例,对照组给予常规治疗及多巴酚丁胺治疗,治疗组给予常规治疗及米力农、低分子肝素治疗,两组治疗7天后均进行疗效评定观察。结果治疗1个疗程后,治疗组总有效率为95.12%,明显优于对照组的78.05%,差异有统计学意义(P0.05)。结论米力农联合低分子肝素治疗慢性肺心病疗效较好,值得临床推广。     

米力农对老年慢性肺源性心脏病心力衰竭患者血浆H2S、BNP的影响

目的 探讨米力农对老年慢性肺源性心脏病(肺心病)心力衰竭患者血浆硫化氢(H2S)、氨基末端B型脑钠肽(BNP)的影响.方法 选择老年慢性肺心病心力衰竭患者65例,随机分为治疗组35例、对照组30例,两组均给予一般治疗,治疗组在此基础上给予米力农治疗.同期选择正常健康体检者57例作为正常对照组.分别观察各组血浆H2S、BNP水平及肺功能、心功能变化.结果 老年慢性肺心病心力衰竭患者血浆H2S低于正常对照组(P＜0.05),BNP高于正常对照组(P＜0.05),且随心功能降低,H2S逐渐降低,BNP逐渐升高.老年慢性肺心病心力衰竭患者治疗后血浆H2S水平和射血分数均较治疗前明显升高(P均＜0.05),且治疗组治疗后血浆H2S水平升高、BNP水平下降更明显(P均＜0.05).结论 米力农治疗老年慢性肺心病心力衰竭患者疗效肯定,其机制可能与改善患者血浆H2S水平、减轻心脏负荷有关.     

复方丹参注射液及鲁南欣康在慢性肺源性心脏病中的疗效观察

目的观察复方丹参注射液及鲁南欣康在慢性肺心病中疗效。方法随机将52例肺心病病人分常规治疗加复方丹参注射液、鲁南欣康的治疗组及仅有常规治疗的对照组,疗程10天,观察疗效。结果治疗组有效率93．3％,对照组为80％。结论复方丹参注射液及鲁南欣康对慢性肺心病治疗有较好的效果。     

藻酸双酯钠治疗慢性肺源性心脏病疗效观察

目的 观察藻酸双酯钠治疗慢性肺源性心脏病的疗效。方法 选择慢性肺心病患者40例，随机分成治疗组和对照组各20例，治疗组在积极抗炎、持续低流量吸氧和对症治疗基础上，用藻酸双酯钠0．15g加入0．9％氧化钠250ml，每日1次静脉滴注，2周为1个疗程。对照组采用常规治疗，观察患者症状和体征的改善情况，观察血气分析和血流的变化。结果 治疗组显效16例，有效3例，无效l例，总有效率95％；对照组显效5例，有效12例，无效3例，总有效率85％。结论 藻酸双酯钠对肺心病加重期疗效确切。     

痰热清注射液治疗肺结核并发慢性肺心病急性加重期40例

目的 观察痰热清注射液治疗肺结核合并慢性肺心病急性加重期的疗效。方法 将80例病人随机分为两组，对照组给予抗结核治疗及肺心病急性加重期基础治疗，并给予抗生素治疗；治疗组在对照组治疗的基础上，加用痰热清注射液治疗，12d为1个疗程，观察两组疗效。结果 治疗组的总有效率为92．5％，明显高于对照组的70．0％（P〈0．05），与对照组单项症状疗效比较，除气短外治疗组均优于对照组（P〈0．05），两组病例均无不良反应发生。结论 痰热清注射液联合抗生素治疗肺结核并发慢性肺心病急性加重期，疗效显著。     

米力农治疗高龄肺心病心力衰竭的安全性分析

目的探讨为高龄肺心病心力衰竭患者应用米力农治疗的实际效果,分析其临床应用价值。方法选取2013年9月-2014年3月我院收治的高龄肺心病心力衰竭患者40例,随机将其分成实验组20例,对照组20例,给予对照组螺内酯、美托洛尔、卡托普利等药物进行常规治疗,实验组在此基础上应用米力农治疗,观察临床疗效及用药安全性。结果两组病例均未发生恶性不良反应,实验组药物治疗有效率为90.0%,高于对照组的65.0%(P0.05)。结论米力农治疗高龄肺心病心力衰竭,疗效显著,安全性高,可在肺心病并心力衰竭患者中推广。     

小剂量米力农治疗充血性心力衰竭的疗效及安全性观察

目的　观察小剂量米力农治疗充血性心力衰竭的疗效及安全性。方法　 90例充血性心力衰竭(CHF)心功能Ⅲ～Ⅳ级的住院患者 ,随机分为A、B、C三组 ,每组各为 30例。A组为对照组 ,予常规抗心衰治疗 ;B组为大剂量米力农组 ,在A组常规治疗的基础上 ,加用大剂量米力农治疗 ( 2 5mg,ivst+ 10mgivqd× 7d) ;C组为小剂量米力农组 ,在A组常规治疗的基础上 ,加用小剂量米力农治疗 ( 5mgivqd× 7d)。结果　A组显效8例 ,有效 11例 ,无效 11例 ,总有效率 6 6 7% ;B组显效 2 4例 ,有效 4例 ,无效 2例 ,有效率 93 3% ;C组显效 2 6例 ,有效 3例 ,无效 1例 ,有效率 96 7% ;A组与B、C组总有效率比较均具有显著统计学差异 (各P <0 0 5,P <0 0 1) ,B组与C组比较差异不明显 (P >0 0 5)。C组患者经小剂量米力农治疗后 ,心律失常发生数明显减少 ,未见其他毒副反应。B组经治疗后仍具有一定数量的室性心律失常。结论　小剂量米力农治疗充血性心力衰竭安全有效 ,值得进一步临床探讨     

rhBNP辅助治疗慢性肺心病心衰65例疗效观察

目的探讨冻干重组人脑利钠肽辅助治疗慢性肺源性心脏病（简称肺心病）心衰的疗效。方法将130例慢性肺心病心衰患者随机分为观察组和对照组各65例,两组均先予抗感染、扩张支气管、小剂量强心、利尿剂等常规对症治疗。观察组在此基础上加用冻干重组人脑利钠肽,7d为1个疗程。1个疗程后判定疗效,观察不良反应发生情况。结果观察组显效42例,有效19例,无效4例,总有效率为93．8％;对照组分别为25、21、19例和70．8％。两组均未出现明显不良反应。结论冻干重组人脑利钠肽辅助治疗慢性肺心病心衰安全有效。     

环磷腺苷葡胺联合米力农与洋地黄治疗慢性肺心病心力衰竭的疗效

目的比较环磷腺苷葡胺联合米力农与洋地黄类强心剂治疗慢性肺心病心力衰竭的疗效与安全性。方法采用随机、平行对照的研究方法,对108例慢性肺心病心力衰竭随机分成两组:治疗组(54例)在常规治疗的基础上加用环磷腺苷葡胺和米力农;观察组(54例)在常规治疗的基础上加用洋地黄(西地兰针),12天一疗程。结果治疗组总有效率94.4%,明显优于观察组66.6%(P<0.01),治疗组心功能指标右室内径、右心室流出道/左心房内径及心胸比例的改善明显优于观察组(P<0.01),肺功能、PaO2、PaCO2及脑钠肽改善明显优于观察组(P<0.01),而心率、血压无明显差异(P>0.05);治疗组不良反应主要有心悸、出汗、头痛,减慢静滴速度症状消失,观察组主要不良反应心律失常,常需停药。结论环磷腺苷葡胺联合米力农治疗慢性肺心病心力衰竭有更好的疗效,更少的副作用,值得临床上进一步推广应用。     

硝酸甘油联合地尔硫卓治疗慢性肺源性心脏病急性加重期患者60例

目的探讨在常规治疗基础上加用硝酸甘油及地尔硫卓治疗慢性肺源性心脏病急性加重期患者的临床价值。方法选取120例慢性肺源性心脏病急性加重期患者随机分成对照组和观察组各60例,对照组患者采用控制感染,畅通呼吸道,改善呼吸功能,纠正缺氧和二氧化碳潴留,控制呼吸和心力衰竭,积极处理并发症等措施治疗。观察组在上述治疗基础上,加用硝酸甘油注射液同时联用地尔硫卓进行治疗。比较两组患者临床症状（气急、乏力、心慌等）和体征的改善情况,以及治疗前后左心室和右心室射血分数、心率和平均住院天数。结果两组患者临床症状及体征均有改善,但观察组的改善程度明显优于对照组;观察组右心功能的改善和心率的控制也优于对照组;观察组住院天数少于对照组。结论对慢性肺心病急性加重期患者,常规治疗基础上加用硝酸甘油及地尔硫卓进行治疗是有益的。     

慢性肺心病并发低钠血症72例分析

目的 探讨慢性肺心病并发低钠血症的发病因素及预防措施。方法 对72例慢性肺心病并发低钠血症患者的临床资料进行回顾性分析。结果 低钠血症发生率为33．3％，合并低渗性脑病者易误诊为肺性脑病。结论 慢性肺心病易并发低钠血症，临床上应提高认识及时纠正。     

Acute effects of intravenous phosphodiesterase inhibition in chronic heart failure: simultaneous pre- and afterload reduction with a single agent.

Intravenous phosphodiesterase inhibition with milrinone is known to have a beneficial effect on haemodynamics in chronic heart failure. Its effect on lower limb capacitance vessels has not been previously investigated. We have studied the effect of intravenous milrinone in 10 patients with severe chronic heart failure. Thirty minutes after commencement of treatment mean cardiac index had risen by 26% and pulmonary artery wedge pressure, systemic vascular resistance and right atrial pressure had fallen by 51, 24 and 89%, respectively (p less than 0.05 for all changes). These changes were maintained for the 2 h observation period with no evidence of tolerance and were accompanied by a 17% increase in venous volume (p less than 0.01) and a 42% increase in ejection fraction (p less than 0.001) at 30 min; at 120 min the improvement in ejection fraction had been maintained and a further increase in venous volume to 38% above baseline was evident. The increase in venous volume was strongly correlated with the decrease in mean pulmonary artery wedge pressure and mean right atrial pressure at 30 min and 2 h (r = -0.80 and -0.69 for mean pulmonary artery wedge pressure, r = -0.88 and -0.56 for mean right atrial pressure). Milrinone therefore has clinically important venodilating properties, in addition to its known effects as an arterial vasodilator and a positive inotrope.     

米力农治疗充血性心力衰竭的血流动力学变化及临床疗效观察

目的　观察米力农对充血性心力衰竭患者血流动力学的影响及临床治疗效果。方法　应用米力农治疗充血性心力衰竭患者 5 0例 ,观察治疗前后心功能级别变化 ,并进行血流动力学及超声心动图指标测定。结果　应用米力农治疗后 1 5分钟起血流动力学指标 RAP、MPP、PCWP、PVR、SVR即较前有明显下降 ( P<0 .0 5 ) ,CI增加 ( P<0 .0 5 ) ,作用持续到 8小时后。对 HR、 SBP、 DBP无影响 ( P>0 .0 5 )。治疗后超声心动图测定显示 SV、 CO、 EF、 FS、E峰较治前明显增加 ( P<0 .0 5 )。A峰明显下降 ( P<0 .0 5 ) ,LVD、RVD、LAD显著缩小 ( P<0 .0 5 )。心功能改善 4 8例 ,总有效率 96 %。结论　米力农能增加心肌收缩力 ,改善心脏舒张功能 ,且有扩血管作用 ,对心力衰竭有明显疗效。     

Preload-dependent hemodynamic effects of milrinone in moderate heart failure.

Milrinone, a bipyridine derivative with positive inotropic and balanced type vasodilating properties, acutely improves cardiac pump function in patients with severe and moderate to severe heart failure. Whether it has similar effects in patients with mild to moderate heart failure is unknown. A hemodynamic evaluation of oral milrinone in dosage of 2.5, 5 and 10 mg was carried out on 3 consecutive days in 18 patients with NYHA class 2.7 heart failure. Patients continued with diuretics and digitalis, administered 15 h before each hemodynamic study. Peak milrinone plasma levels ranged from 77 to 252 micrograms/ml and were attained at 60-90 min following administration. Concomitantly, milrinone significantly reduced pulmonary wedge and right atrial pressures with 24, 47 and 44, and 25, 42 and 38% with the 2.5-, 5- and 10-mg doses, respectively. Milrinone had no effect on cardiac or stroke indices with either dose. Moreover, systemic vascular resistance only decreased by 12% with the highest dose, together with a 7% fall in mean arterial pressure and a 13% rise in heart rate (all p less than 0.05 vs. baseline). Patients were subsequently grouped depending on baseline pulmonary wedge pressure greater than or equal to 18 mm Hg (Gr I, n = 9) or less than 18 mm Hg (Gr II, n = 9). Changes in pulmonary wedge, pulmonary artery and right atrial pressure were similar in both groups following each dose. In contrast, the effect on cardiac pump function clearly differed in patients with high versus normal baseline wedge pressure. In Gr I, cardiac index increased significantly by 16% (5 and 10 mg). In Gr II, cardiac index decreased with 13% following the 10-mg dose (p less than 0.05 vs. baseline). When maximal individual changes in cardiac index were compared, 10 mg milrinone resulted in an improvement of cardiac index in all patients with baseline wedge pressures greater than 15 mm Hg, but in a decrease in cardiac index in patients with lower wedge pressures. It is concluded that milrinone induces contrasting effects on cardiac pump function in patients with mild to moderate heart failure, which may negatively affect its early and, possibly, also late efficacy in this patient group.     

Milrinone in heart failure. Effects on exercise haemodynamics during short term treatment

The effects of milrinone, a new bipyridine inotropic agent, on the haemodynamic responses to treadmill exercise were studied in 12 patients with congestive heart failure. Four weeks' treatment with milrinone 20 mg daily produced an improvement in left ventricular function during exercise as reflected by significant increments in cardiac index and stroke volume index without change in pulmonary capillary wedge pressure. Systemic oxygen consumption, measured at submaximal exercise, also increased suggesting that the drug induced rise in stroke output was associated with improved skeletal muscle perfusion. Maximum exercise capacity increased. Importantly, the beneficial effects of milrinone on exercise haemodynamics and exercise tolerance were sustained throughout the four week treatment period. No drug related side effects occurred. After treatment with milrinone was stopped left ventricular function deteriorated to a level slightly, but significantly, worse than that before treatment. These observations indicate a potentially useful role for milrinone in treating heart failure.     

Milrinone in heart failure. Effects on exercise haemodynamics during short term treatment.

The effects of milrinone, a new bipyridine inotropic agent, on the haemodynamic responses to treadmill exercise were studied in 12 patients with congestive heart failure. Four weeks' treatment with milrinone 20 mg daily produced an improvement in left ventricular function during exercise as reflected by significant increments in cardiac index and stroke volume index without change in pulmonary capillary wedge pressure. Systemic oxygen consumption, measured at submaximal exercise, also increased suggesting that the drug induced rise in stroke output was associated with improved skeletal muscle perfusion. Maximum exercise capacity increased. Importantly, the beneficial effects of milrinone on exercise haemodynamics and exercise tolerance were sustained throughout the four week treatment period. No drug related side effects occurred. After treatment with milrinone was stopped left ventricular function deteriorated to a level slightly, but significantly, worse than that before treatment. These observations indicate a potentially useful role for milrinone in treating heart failure.     

Novel role of phosphodiesterase inhibitors in the management of end-stage heart failure

In advanced heart failure(HF), chronic inotropic therapy with intravenous milrinone, a phosphodiesterase Ⅲ inhibitor, is used as a bridge to advanced management that includes transplantation, ventricular assist device implantation, or palliation. This is especially true when repeated attempts to wean off inotropic support result in symptomatic hypotension, worsened symptoms, and/or progressive organ dysfunction. Unfortunately, patients in this clinical predicament are considered hemodynamically labile and may escape the benefits of guidelinedirected HF therapy. In this scenario, chronic milrinone infusion may be beneficial as a bridge to introduction of evidence based HF therapy. However, this strategy is not well studied, and in general, chronic inotropic infusion is discouraged due to potential cardiotoxicity that accelerates disease progression and proarrhythmic effects that increase sudden death. Alternatively, chronic inotropic support with milrinone infusion is a unique opportunity in advanced HF. This review discusses evidence that long-term intravenous milrinone support may allow introduction of beta blocker(BB) therapy. When used together, milrinone does not attenuate the clinical benefits of BB therapy while BB mitigates cardiotoxic effects of milrinone. In addition, BB therapy decreases the risk of adverse arrhythmias associated with milrinone. We propose that advanced HF patients who are intolerant to BB therapy may benefit from a trial of intravenous milrinone as a bridge to BB initiation. The discussed clinical scenarios demonstrate that concomitant treatment with milrinone infusion and BB therapy does not adversely impact standard HF therapy and may improve left ventricular function and morbidity associated with advanced HF.     

Milrinone in congestive heart failure: acute and chronic hemodynamic and clinical evaluation

Acute and chronic hemodynamic and clinical responses to milrinone, a new oral inotrope-vasodilator agent, were evaluated prospectively in 37 patients with severe congestive heart failure. The majority of patients (n = 31) had not responded to prior vasodilator therapy, with a substantial number (n = 8) requiring intravenous inotropic support at the time of initial study. All patients showed acute hemodynamic improvement with oral milrinone, and an optimal maintenance dose was chosen for each patient during dose-ranging studies (average dose 48 mg/day). Milrinone was discontinued before follow-up hemodynamic study in 12 patients (because of worsening congestive heart failure in 6 patients, sudden death in 3 patients, arrhythmia in 1 patient and refusal by 2 patients). Hemodynamic effects of milrinone both acutely and after chronic therapy (average 37 days) were compared in the remaining 25 patients. Acutely, mean cardiac index increased from 1.9 +/- 0.5 to 2.5 +/- 0.5 liters/min per m2 (p less than 0.001), and mean pulmonary capillary wedge pressure decreased from 28 +/- 9 to 18 +/- 8 mm Hg (p less than 0.001). When oral milrinone was readministered after chronic therapy, mean cardiac index increased from 1.9 +/- 0.5 to 2.5 +/- 1.7 liters/min per m2 (p less than 0.001), and pulmonary capillary wedge pressure decreased from 27 +/- 8 to 20 +/- 8 mm Hg (p less than 0.001) at 1 hour. New York Heart Association functional class improved in 18 of the 25 patients treated over a long-term period (mean 5.5 +/- 2.3 months).(ABSTRACT TRUNCATED AT 250 WORDS)