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目的观察米力农治疗先天性心脏病(CHD)并肺动脉高压(PH)的临床疗效及其对血流动力学的影响。方法研究对象为2004—2007年广西壮族自治区人民医院收治的45例重症CHD并PH患儿,随机分为A、B2组。A组25例为米力农组,米力农剂量为0.5μg/(kg.min),B组20例为多巴胺组,剂量均为5μg/(kg.min),各组持续给药5d,观察米力农治疗后临床疗效、肺循环血流量/体循环血流量(Qp/Qs)、左室心排指数(LV-CI)、右室心排指数(RV-CI)、肺动脉收缩压(PASP)、心率(HR)、体循环收缩压(SBP)等血流动力学指标的变化,并与多巴胺组进行比较。结果米力农组用药后5d,患儿临床症状体征好转、PASP、Qp/Qs明显降低(P<0.05),LV-CI升高(P<0.05),而HR、SBP、RV-CI无显著变化(P>0.05),总有效率92.0%;多巴胺组临床有效率仅为75.0%,治疗前后血流动力学指标改善不明显(P>0.05);A、B两组治疗后临床疗效、血流动力学指标比较有统计学意义(P<0.05)。结论米力农具有正性肌力和扩血管作用,对肺血管床有选择性扩张作用,能明显改善重症CHD并PH患儿的临床症状、心功能和降低肺动脉压力,不影响血压和心率。
Objective To observe the clinical efficacy of milrinone in the treatment of congenital heart disease (CHD) and pulmonary hypertension (PH) and its effect on hemodynamics. Methods The subjects were 45 severe CHD and PH children admitted to People’s Hospital of Guangxi Zhuang Autonomous Region from 2004 to 2007 and were randomly divided into A and B2 groups. 25 cases of group A were milrinone, the dose of milrinone was 0.5μg / (kg · min), 20 cases of group B were dopamine, the dosage was 5μg / (kg · min) To observe the clinical effect of Milrinone, Qp / Qs, LV-CI, RV-CI, PASP, , Heart rate (HR), systemic systolic blood pressure (SBP) and other hemodynamic parameters, and compared with the dopamine group. Results The symptoms and signs of PML, Qp / Qs were significantly decreased (P <0.05) and the LV-CI was increased (P <0.05), while the HR, SBP and RV-CI were no significant (P> 0.05), the total effective rate was 92.0%; the clinical effective rate of dopamine group was only 75.0%, and the hemodynamic indexes did not improve obviously before and after treatment (P> 0.05); The clinical curative effect of A and B groups after treatment The flow mechanics index was statistically significant (P <0.05). Conclusion Milrinone has positive inotropic and vasodilator effects and selectively expands the pulmonary vascular bed. It can significantly improve clinical symptoms, cardiac function and pulmonary artery pressure in children with severe CHD and PH without affecting blood pressure and heart rate.