米力农对先天性心脏病并肺动脉高压及心力衰竭患儿的术前干预作用

Effect of Milrinone on Congenital Heart Disease Combined with Pulmonary Artery Hypertension and Congestive Heart Failure in Children before Operation

目的探讨米力农对小儿先天性心脏病(CHD)并肺动脉高压(PAH)及心力衰竭(CHF)术前治疗的效果。方法收集2006年1月-2008年7月上海交通大学附属儿童医院ICU收治的CHD患儿40例。年龄1个月～3岁。均为左向右分流型CHD,并PAH及CHF。将患儿随机分为研究组与对照组,各20例,二组病种、年龄、心功能及PAH程度比较无显著性差异。二组患儿均应用强心、利尿及扩血管治疗,另外,研究组20例加米力农静脉维持[0.5μg/(kg.min)],对照组20例加多巴胺和多巴酚丁胺各5μg/(kg.min)静脉维持。分别于用药前、静脉维持用药72h及停药后2h通过彩色多普勒超声心动图检测二组各项心脏收缩、舒张功能及肺动脉压力指标。结果研究组用药72h各项心脏收缩功能指标(心脏指数、左室射血分数及左室短轴缩短率)和舒张功能指标(左室收缩时间间期、右室收缩时间间期及二尖瓣E峰和A峰比值)均显著优于对照组(Pa<0.05),肺动脉压力下降程度显著高于对照组(P<0.05);研究组改善心功能有效率显著高于对照组(P<0.05)。结论米力农对CHD并PAH及CHF患儿具有正性肌力和扩血管作用,能明显改善心功能和降低肺动脉压力,为手术纠正心脏畸形提供良好时机。

Objective To investigate the effect of intravenous Milrinone on children with congenital heart disease （CHD） combined with pulmonary artery hypertension （PAH） and congestive heart failure （CHF） before operation.Methods Forty CHD children with PAH and CHF aged 1 month to 3 years were collected.All the 40 children were randomly divided into research group and control group.Each group had 20 children and there were no significant differences in disease,PAH,cardiac function and age.All children were treated with digoxin,diuretic and vasodilator.Twenty children in research group were also treated with intravenous Milrinone[0.5 μg/（kg·min）]and the other 20 children in control group were added with intravenous Dopamine and dobutamine [5 μg/（kg·min）].The cardiac function （systolic and diastolic function） and pulmonary artery pressure with echocardiography before drug treated,drug maintaining 72 h in vein and 2 h after drug treated were detected.Results The cardiac systolic and diastolic functions （cardiac index,left ventricular ejection fraction,left ventricular fractional shortening,right lentricalar systolic interval,right ventricular systolic time interphase and E/A] of Milrinone group were significantly better improved than those in control group （Pa〈0.05）.Conclusions Milrinone has both inotropic and vasodilative effects.It will enable an ob-vious improvement on cardiac functions as well as pulmonary artery pressure.Intravenous Milrinone in CHD patients with CHF could give a good chance for operation.