β阻滞剂治疗慢性心衰恶化时合用米力农疗效观察

Effects of Milrinone on Worsening Chronic Heart Failure with Prolonged β-Blocker Treatment

目的探讨长期接受β受体阻滞剂(β-blocker,BB)治疗的慢性心衰(CHF)患者急性加重时,B B联合米力农(mil-rinone,MLN)治疗的疗效。方法连续收集在我院急诊科因心衰加重而就诊的30例门诊长期服用 BB 的 CHF 患者,他们均有明显的心脏扩大病史,记录超声心动图(LVEDD,LVESD,EF)、心率、血压、临床表现,比较使用 BB 前、使用 BB 加用 MLN 前、BB 联用 MLN 后3组数据的变化。结果慢性心衰患者长期使用 BB 后,即使急性加重,所测 EF 值仍较未使用 BB 前增加(EF 由使用前的51.37%±16.38%增至60.86%±13.59%,P<0.05);急性加重期,BB 和 MLN 联用,EF 值仍可较加用 MLN 前上升(由60.86%±13.59%增至72.94%±9.19%,P<0.05)。而且 BB 联用 MLN,心率和血压未见增高,BB 降低心肌耗氧量作用未被抵消。结论长期服用 BB 的慢性心衰患者,急性加重时应尽可能不停用 BB,在此基础上联用正性肌力药物为宜。

Objective To investigate the effects of milrinone on worsening chronic heart failure （CHF） in patients with prolonged treatment of β-blocker （BB）. Methods 30 patients with CHF on prolonged BB treatment who came to emergency department for acute exacerbation of heart failure were enrolled subsequentially. Cardiac enlargement history were found in all these patients： UCG parameters （LVEDD, LVESD, EF）, HR, BP and clinical manifestations were compared among three phases（ before BB administration, prolonged treatment of BB but before MLN dripping and combined treatment of BB and MLN）. Results Prolonged usage of BB significantly improved heart function, even when worsening of heart failure occurred （EF increased from 51.37% ± 16. 38% to 60. 86% ± 13.59%, P 〈0. 05） ; combination of MLN could further significantly impreve EF （from 60. 86% ± 13.59% to 72. 94% ±9. 19 % , P 〈0. 05）. MLN did not antagonize the hemodynamic effects of BB, with no increase of HR and BP. Conclusion When acute exacerbation of heart failure happened in patients on prolonged BB treatment, BB should not be ceased if possible, MLN can be added on this occasion.