奥普力农治疗慢性肺源性心脏病难治性心力衰竭效果观察

Efficacy of olprinone on refractory heart failure in patients with chronic pulmonary heart disease

目的观察慢性肺源性心脏病(肺心病)难治性心力衰竭(心衰)患者应用奥普力农治疗前后心功能、肺功能、心率变异性和心肌功能综合指数变化,探讨治疗效果和安全性。方法2019年1月—2020年7月河南省电力医院诊治慢性肺心病难治性心衰患者109例,均在吸氧、控制液体入量、利尿、强心、抗感染、扩张血管、纠正水电解质紊乱及酸碱失衡等常规治疗基础上给予盐酸奥普力农,5 min内泵注负荷剂量10μg/kg后,以0.1~0.3μg/(kg·min)维持,必要时增加至0.4μg/(kg·min),24 h总剂量不超过0.6 mg/kg,必要时行无创机械通气。治疗7 d评价疗效。比较治疗前及治疗7 d后血清白细胞介素(IL)-6、IL-1β、肿瘤坏死因子-α(TNF-α)、最大呼气流量(PEF)、用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))/FVC、6 min步行试验(6MWT)距离、R-R间期标准差(SDNN)、R-R间期标准差大于50 ms百分数(pNN50)、每5 min节段平均心博间期均值标准差(SDANN)、相邻R-R间期差值均方根(rMSSD)、心肌功能综合指数。随访6个月,记录主要不良心脏事件发生情况。结果(1)109例中54例行无创机械通气,住院(15.23±4.02)d,病情稳定出院。治疗7 d,疗效显著51例,有效28例,无效30例,总有效率为72.48%。(2)治疗7 d后血清IL-6[(12.10±2.18)ng/L]、IL-1β[(0.17±0.03)μg/L]、TNF-α[(5.53±1.87)mg/L]水平及心肌功能综合指数(0.37±0.11)均低于治疗前[(35.75±5.63)ng/L、(0.37±0.09)μg/L、(14.55±3.14)mg/L、0.93±0.12](P<0.05),PEF[(4.78±0.34)L/s]、FVC[(2.85±0.12)L]、FEV_(1)/FVC[(73.78±2.35)%]、SDNN[(109.37±3.46)ms]、pNN50[(4.39±0.22)%]、SDANN[(80.95±4.20)ms]和rMSSD[(32.59±2.98)ms]均高于治疗前[(3.35±0.42)L/s、(2.09±0.13)L、(51.65±1.98)%、(77.55±3.59)ms、(3.09±0.15)%、(66.17±3.87)ms、(22.55±1.42)ms](P<0.05),6MWT距离[(402.51±34.65)m]长于治疗前[(237.15±34.58)m](P<0.05)。(3)随访期间因心力衰竭再住院10例,发生恶性心律失常3例,心源性死亡2例,主要不良心脏事件发生率为13.76%。结论慢性肺心病难治性心衰患者在常规治疗基础上应用奥普力农治疗的短期效果良好,可减轻炎性反应,改善心、肺功能,纠正心率变异性,主要不良心脏事件发生率低。

Objective To observe the changes of cardiac function,pulmonary function,heart rate variability and composite index of myocardial function in patients with refractory heart failure with chronic pulmonary heart disease before and after treatment with olprinone,and to investigate the therapeutic efficacy and safety.Methods From January 2019 to July 2020,109 patients with refractory heart failure with chronic pulmonary heart disease were diagnosed and treated in Henan Electric Power Hospital.On the basis of conventional treatments such as oxygen intake,fluid intake control,diuresis,cardiotonicity,anti-infection,vasodilatation,correction of water-electrolyte disorders and acid-base imbalance,all patients were pumped with 10μg/kg oprylonium hydrochloride within 5 min,followed with 0.1 to 0.3μg/(kg·min)for maintenance,and 0.4μg/(kg min)if necessary,with the total dose of 0.6 mg/kg or below in 24 h.Non-invasive ventilation was performed if necessary.The efficacy was evaluated after 7-d treatment.The serum interleukin(IL)-6,IL-1β,tumor necrosis factor-α(TNF-α),maximal expiratory flow(PEF),forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1))/FVC,6-min walking test(6MWT)distance,standard deviation of normal R-R intervals(SDNN),percentage of adjacent RR intervals differing by more than 50 ms(pNN50),standard deviation of average 5-min normal R-R intervals(SDANN),root mean square of successive R-R intervals differences(rMSSD),and the composite index of myocardial function were compared before and after treatment.The patients were followed up for 6 months to record the major adverse cardiac events.Results(1)Among the 109 patients,54 received non-invasive mechanical ventilation,and were discharged after(15.23±4.02)d of hospital stay.The 7-d treatment result was significantly effective in 51 patients,effective in 28,and ineffective in 30,with the total effective rate of 72.48%.(2)The levels of serum IL-6,IL-1p,TNF-αand myocardial function composite index were lower after 7-d treatment[(12.10±2.18)ng/L,(0.17±0.03)μg/L,(5.53±1.87)mg/L,0.37±0.11]than thosebeforetreatment[(35.75±5.63)ng/L,(0.37±0.09)μg/L,(14.55±3.14)mg/L,0.93±0.12](P<0.05),PEF,FVC,FEV_(1)/FVC,SDNN,pNN50,SDANN and rMSSD were higher after 7-d treatment[(4.78±0.34)L/s,(2.85±0.12)L,(73.78±2.35)%,(109.37±3.46)ms,(4.39±0.22)%,(80.95±4.20)ms,(32.59±2.98)ms]than those before treatment[(3.35±0.42)L/s,(2.09±0.13)L,(51.65±1.98)%,(77.55±3.59)ms,(3.09±0.15)%,(66.17±3.87)ms,(22.55±1.42)ms](P<0.05),and 6MWT distance was longer after 7-d treatment[(402.51±34.65)m]than that before treatment[(237.15±34.58)m](P<0.05).(3)During the follow-up period,10 patients were re-hospitalized due to heart failure,3 developed malignant arrhythmia,2 developed cardiac death,and the incidence of major adverse cardiac events was 13.76%.Conclusion The application of olprinone in addition to the conventional treatments has a good short-term efficacy on refractory heart failure and pulmonary heart disease,since it can reduce the inflammatory response,store cardiopulmonary function,correct heart rate variability,and reduce the incidence of major adverse cardiac events.