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米力农联合洋地黄治疗尿毒症血液透析合并心力衰竭的临床疗效*
骆强,卿山林,田中,姜涵文
0
(成都医学院第二附属医院·核工业四一六医院肾脏内科)
摘要:
【摘要】 目的 分析米力农联合洋地黄治疗尿毒症血液透析合并心力衰竭患者的临床疗效。 方法 选择2014年1月~2018年4月在本院接受血液透析治疗的尿毒症合并心力衰竭患者;67例符合纳入与排除标准患者按随机数字表法分观察组(n=30)与对照组(n=37)。对照组给予洋地黄,观察组在对照组基础上联合米力农。比较两组临床疗效、血气分析、超声心功能指标、心肌标记物水平,并统计28 d病死率及再入院率、不良反应发生率。 结果 两组疗效等级、总有效率、28 d死亡率、28 d再入院率比较差异均无统计学意义(P>0.05);治疗后,心率(HR)、二氧化碳分压 (PaCO2)、B型脑钠肽(BNP)较治疗前显著下降,氧分压(PaO2)、每搏输出量(SV)、心排血量(CO)、心脏指数 (CI)、左室射血分数(LVEF)、二尖瓣血流舒张早期最大流速与舒张晚期最大流速的比值(E/A)、硫化氢(H2S)较治疗前显著上升,且观察组HR、PaCO2、BNP显著低于对照组,PaO2、SV、CO、CI、LVEF、E/A、H2S显著高于对照组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。 结论 米力农联合洋地黄治疗血液透析的尿毒症合并心力衰竭患者疗效安全性可靠,对血流动力学、心功能的改善程度优于单一洋地黄治疗。
关键词:  米力农  洋地黄  尿毒症  血液透析  心力衰竭
DOI:
基金项目:四川省卫生和计划生育委员会科研课题(17PJ075)
Clinical curative effect of milrinone combined with digitalis in the treatment of uremic hemodialysis with heart failure
LUO Qiang,QING Shanlin,TIAN Zhong*,JIANG Hanwen
(Department of Nephrology, 416 Hospital of Nuclear Industry, The Second Affiliated Hospital of Chengdu Medical College)
Abstract:
【Abstract】 Objective To analyze the clinical curative effect of milrinone combined with digitalis in the treatment of uremic hemodialysis with heart failure. Methods 67 patients with uremia complicated with heart failure underwent hemodialysis in the hospital from January 2014 to April 2018 were selected as subjects. They were divided into the observation group (n=30) and the control group (n=37) by the random number table method. The control group was treated with digitalis, while the observation group was treated with milrinone on the basis of the treatment for control group. The clinical curative effect, blood gas analysis, ultrasonic cardiac parameters and myocardial markers were compared between the two groups. The 28day mortality rate, readmission rate and incidence of adverse reactions were statistically analyzed. Results There was no significant difference in the grade of curative effect, total effective rate, 28day mortality or 28 day readmission rate between the two groups (P>0.05). Heart rate (HR), partial pressure of carbon dioxide (PaCO2) and brain natriuretic peptide (BNP) decreased significantly, while partial pressure of oxygen (PaO2), stroke volume (SV), cardiac output (CO), cardiac index (CI), left ventricular ejection fraction (LVEF), the ratio of the maximum early diastolic flow velocity to the maximum late diastolic flow velocity (E/A) and hydrogen sulfide (H2S) increased significantly after treatment. The HR, PaCO2 and BNP in the observation group were significantly lower than those in the control group. PaO2, SV, CO, CI, LVEF, E/A and H2S were significantly higher than those in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Milrinone combined with digitalis is effective and safe in the treatment of uremic hemodialysis with heart failure. The improvement of hemodynamics and cardiac function is better than that of digitalis alone.
Key words:  Milrinone  Digitalis  Uremia  Hemodialysis  Heart failure

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