米力农短期小剂量给药联合无创呼吸机治疗心力衰竭合并Ⅱ型呼吸衰竭的重症肺源性心脏病高龄患者的临床疗效和安全性

Clinical efficacy and safety of short-term administration of low-dose milrinone combined with non-invasive respiratory ventilator for treating advanced age patients with severe pulmonary heart disease complicated with heart failure and type Ⅱ respiratory

目的探讨米力农短期小剂量给药联合无创呼吸机治疗心力衰竭合并Ⅱ型呼吸衰竭的重症肺源性心脏病高龄患者的临床疗效及安全性。方法将62例心力衰竭合并Ⅱ型呼吸衰竭的重症肺源性心脏病高龄患者随机分为治疗组和对照组,各31例。对照组患者给予无创呼吸机治疗联合吸氧、抗感染、强心、利尿、纠正电解质紊乱治疗,治疗组在此基础上加用米力农泵入治疗。比较两组治疗前后PaO2、PaCO2、脑利钠肽水平,评价两组临床疗效,并记录两组不良反应发生情况。结果治疗前两组PaO2、PaCO2、脑利钠肽水平比较,差异无统计学意义(P>0.05)。治疗后两组PaO2高于治疗前,PaCO2、脑利钠肽水平低于治疗前(P<0.05),但两组上述指标比较差异无统计学意义(P>0.05)。治疗组治疗有效率高于对照组(P<0.05)。两组心肌梗死发生率、死亡率差异无统计学意义(P>0.05)。结论米力农短期(≤7 d)、小剂量泵入给药联合无创呼吸机治疗心力衰竭合并Ⅱ型呼吸衰竭的重症肺源性心脏病高龄患者较单独使用无创呼吸机疗效好,但可能存在诱发心肌梗死风险,使用时应权衡利弊。

Objective To investigate the clinical efficacy and safety of short-term administration of low-dose milrinone combined with non-invasive respiratory ventilator for treating the advanced age patients with severe pulmonary heart disease who were complicated with heart failure and type Ⅱ respiratory failure.Methods Sixty-two advanced age patients with severe pulmonary heart disease who were complicated with heart failure and type Ⅱ respiratory failure were randomly allocated to treatment group or control group,with 31 cases in each group.The patients in the control group were treated with non-invasive ventilator combined with oxygen inhalation,anti-infection,cardiotonic therapy,diuretic therapy,and correction of electrolyte disorder,and the patients in the treatment group were administered milrinone with pump infusion on this basis.The levels of PaO2,PaCO2 and brain natriuretic peptide(BNP) before and after treatment were compared between the two groups,the clinical efficacy of the two groups was evaluated,and the incidence of adverse reactions in the two groups was recorded.Results Before treatment,there were no statistically significant differences in the levels of PaO2,PaCO2 and BNP between the two groups(P>0.05).Compared to pre-therapy,the PaO2 increased,and the PaCO2 and BNP decreased in both groups after therapy(P<0.05),but no statistically significant difference were found in the above indexes between the two groups(P>0.05).The effective rate of the treatment group was higher than that of the control group(P<0.05).There were no statistically significant differences in the incidence rate of myocardial infarction and mortality rate between the two groups(P>0.05).Conclusion For the advanced age patients with severe pulmonary heart disease who were complicated with heart failure and type Ⅱ respiratory failure,short-term(≤7 d) pump infusion of low-dose milrinone combined with non-invasive respiratory ventilator achieves a better efficacy as compared with non-invasive respiratory ventilator alone,but may has a risk of myocardial infarction,and thus the pres and cons should be weighted when application.