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目的:观察米力农与硝普钠联合参麦治疗急性心肌梗死(AMI)后心力衰竭的临床疗效及安全性。方法:选择我院住院治疗的AMI后出现心力衰竭患者180例,心功能均为KillipⅡ~Ⅲ级,随机分为基础治疗组、硝普钠联合参麦治疗组及米力农治疗组,每组各60例。硝普钠联合参麦组和米力农组在基础治疗上加用硝普钠和参麦或米力农治疗。硝普钠联合参麦组给予硝普钠10μg/min,缓慢静脉泵入,根据血压情况逐步上调剂量至30~50μg/min,静脉持续泵入,参麦100ml静脉滴注,1次/d,7d为1个疗程。米力农治疗组给予米力农负荷量50μg/kg,10min缓慢静脉注射,之后0.5μg/(kg·min)静脉持续泵入,7d为1个疗程。治疗前后评估患者心功能指标变化。结果:3组患者治疗后脑钠肽(BNP)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、心排血量(CO)、心率(HR)、中心静脉压(CVP)等指标较治疗前均有明显改善(P<0.05,P<0.01),而米力农组治疗后BNP、LVEF、LVEDD、CO、HR、CVP水平明显优于基础治疗组及硝普钠联合参麦组(P<0.05,P<0.01);硝普钠联合参麦组治疗后BNP、LVEF、CO、CVP水平明显优于基础治疗组(P<0.05,P<0.01);硝普钠联合参麦治疗后SBP、DBP较治疗前降低(P<0.05,P<0.01),而基础治疗组及米力农组治疗后SBP、DBP与治疗前比较差异无统计学意义(P>0.05)。治疗期间,3组患者不良反应发生率及病死率差异无统计学意义(P>0.05)。结论:米力农及硝普钠联合参麦均能有效治疗AMI后心力衰竭,而短期、小剂量持续应用米力农治疗AMI后心力衰竭更为有效。
Objective: To observe the clinical efficacy and safety of milrinone and sodium nitroprusside combined with shenmai in treating heart failure after acute myocardial infarction (AMI). Methods: One hundred and eighty patients with heart failure who were hospitalized after AMI were selected and their cardiac function were all Killip Ⅱ ~ Ⅲ. They were randomly divided into basic treatment group, sodium nitroprusside combined with Shenmai treatment group and milrinone treatment group. 60 cases each. Sodium nitroprusside joint Shenmai and Milirong group in the basic treatment plus sodium nitroprusside and Shenmai or milrinone treatment. Sodium nitroprusside combined with Shenmai group were given sodium nitroprusside 10μg / min, slow intravenous infusion, according to blood pressure gradually increase the dose to 30 ~ 50μg / min, continuous intravenous infusion of Shenmai 100ml intravenous infusion, 1 / d, 7d for a course of treatment. Milrinone treatment group was given milrinone loading 50μg / kg, 10min slow intravenous injection, followed by continuous intravenous 0.5μg / (kg · min) pump, 7d for a course of treatment. Patients before and after treatment to assess changes in cardiac function. Results: The BNP, LVEF, LVEDD, CO, HR and CVP in the three groups after treatment were significantly higher than those in the control group (P <0.05, P <0.01), while the levels of BNP, LVEF, LVEDD, CO, HR and CVP in the Milrinone group were significantly better than those in the basic treatment group and sodium nitroprusside (P <0.05, P <0.01). The levels of BNP, LVEF, CO, CVP in SNP combined with Shenmai group were significantly better than those in the basic treatment group (P <0.05, P <0.01) The SBP and DBP of wheat after treatment were lower than those before treatment (P <0.05, P <0.01). There was no significant difference in SBP and DBP before and after treatment between basic treatment and Milian group (P> 0.05). There was no significant difference in the incidence of adverse reactions or mortality between the three groups during treatment (P> 0.05). Conclusion: Milrinone and sodium nitroprusside combined with shenmai are effective in treating heart failure after AMI. Short-term and small-dose continuous administration of milrinone is more effective in treating heart failure after AMI.