米力农联合无创机械通气对重症心力衰竭的疗效分析

Therapeutic effect of Milrinone combined with non-invasive mechanical ventilation on severe heart failure

目的观察米力农联合无创机械通气对重症心力衰竭(SHF)的治疗效果。方法选取2018年2月—2019年6月安阳市人民医院收治的92例SHF患者,简单随机化法分为对照组和联合组,各46例,对照组在常规治疗基础上给予无创机械通气治疗,联合组在对照组基础上给予米力农治疗。对比2组治疗7 d脱机率、入住ICU时间、治疗前后心功能指标[心脏指数(CI)、左室射血分数(LVEF)、左室短轴缩短率(LVFS)],对比2组临床疗效及治疗前后血清N端脑钠肽前体(NT-proBNP)、肌钙蛋白Ⅰ(cTNⅠ)、Ⅲ型前胶原氨基端肽(PⅢNP)、超敏C反应蛋白(hs-CRP)水平,对比治疗期间不良反应发生率、随访6个月再住院和死亡情况。结果联合组治疗7 d脱机率均高于对照组,入住ICU时间短于对照组,差异均有统计学意义(P<0.05);治疗后2组CI、LVEF、LVFS均高于治疗前,且联合组高于对照组,差异均有统计学意义(P<0.05);联合组治疗总有效率(89.13%)高于对照组(71.74%),差异有统计学意义(P<0.05);治疗后2组血清NT-proBNP、cTNⅠ、PⅢNP、hs-CRP水平均低于治疗前,且联合组低于对照组,差异均有统计学意义(P<0.05);治疗期间2组不良反应总发生率比较,差异无统计学意义(P>0.05);随访6个月期间2组患者病死率比较,差异无统计学意义(P>0.05),联合组再住院率(10.87%)低于对照组(32.61%),差异有统计学意义(P<0.05)。结论米力农联合无创机械通气可有效改善SHF患者呼吸功能,减轻心肌损伤、改善心脏功能,降低再住院率,安全可靠。

Objective To observe the therapeutic effect of milrinone combined with non-invasive mechanical ventilation on severe heart failure(SHF).Methods Totally 92 patients with SHF admitted to our hospital from February 2018 to January 2019 were randomized into control group and combination group,46 cases in each group.The control group was treated with non-invasive mechanical ventilation on the basis of routine treatment,and the combination group was treated with milrinone on the basis of control group.The 7-day weaning rate,7-day extubation rate,ICU stay time,cardiac function indexes before and after treatment[cardiac index(CⅠ),left ventricular ejection fraction(LVEF),left ventricular short axis shortening rate(LVFS)]were compared between the two groups.The clinical efficacy and serum levels of N-terminal brain natriuretic peptide precursor(NT-proBNP),troponinⅠ(cTNⅠ),procollagen typeⅢamino terminal peptide(PⅢNP)and hypersensitive C-reactive protein(hs-CRP)were compared between the two groups before and after treatment.Incidence of adverse reactions during treatment,re-hospitalization after 6 months of follow-up and mortality were compared.Results The 7-day weaning rate and 7-day extubation rate in the combined group were higher than those in the control group,and the ICU stay time was shorter than that in the control group(P<0.05).After treatment,CⅠ,LVEF and LVFS in the two groups were higher than those before treatment,and those in the combined group were higher than those in the control group(P<0.05).There was significant difference in the clinical efficacy grade distribution between the combined group and the control group(P<0.05).The total effective rate of the combined group(89.13%)was higher than that of the control group(71.74%)(P<0.05).Serum NT-proBNP,cTNⅠ,PⅢNP and hs-CRP levels in the two groups after treatment were lower than those before treatment,and those in the combined group were lower than those in the control group(P<0.05).There were no significant differences in the incidence of tachycardia,headache,hypotension,vomiting and total adverse reactions between the two groups during treatment(P>0.05).There was no significant difference in mortality between the two groups during the 6-month follow-up(P>0.05).The re-hospitalization rate in combined group(10.87%)was lower than that in control group(32.61%)(P<0.05).Conclusion Milrinone combined with non-invasive mechanical ventilation can effectively improve the respiratory function of SHF patients,reduce myocardial damage,improve cardiac function,and reduce the rate of rehospitalization,which is safe and reliable.