米力农治疗小儿先天性心脏病并肺动脉高压的血流动力学效应分析  

Study on the hemodynamics effect of milrinone on treating severe congenital heart disease (CHD) of children with pulmonary hypertension

作　　者：王耀菊[1] 杜华[1] 代艳[1] 赵毅兰[1] 

机构地区：[1]广西壮族自治区人民医院,广西南宁530021

出　　处：《中国实用儿科杂志》2008年第10期747-749,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的观察米力农治疗先天性心脏病(CHD)并肺动脉高压(PH)的临床疗效及其对血流动力学的影响。方法研究对象为2004—2007年广西壮族自治区人民医院收治的45例重症CHD并PH患儿,随机分为A、B2组。A组25例为米力农组,米力农剂量为0.5μg/(kg.min),B组20例为多巴胺组,剂量均为5μg/(kg.min),各组持续给药5d,观察米力农治疗后临床疗效、肺循环血流量/体循环血流量(Qp/Qs)、左室心排指数(LV-CI)、右室心排指数(RV-CI)、肺动脉收缩压(PASP)、心率(HR)、体循环收缩压(SBP)等血流动力学指标的变化,并与多巴胺组进行比较。结果米力农组用药后5d,患儿临床症状体征好转、PASP、Qp/Qs明显降低(P<0.05),LV-CI升高(P<0.05),而HR、SBP、RV-CI无显著变化(P>0.05),总有效率92.0%;多巴胺组临床有效率仅为75.0%,治疗前后血流动力学指标改善不明显(P>0.05);A、B两组治疗后临床疗效、血流动力学指标比较有统计学意义(P<0.05)。结论米力农具有正性肌力和扩血管作用,对肺血管床有选择性扩张作用,能明显改善重症CHD并PH患儿的临床症状、心功能和降低肺动脉压力,不影响血压和心率。Objective To study the clinical curative effect of using milrinone on treating children severe congenital heart disease （ CHD ） complicated with pulmonary hypertension （ PH ）, and the effect on hemodynamics. Methods Forty-five severe CHD children with PH were divided into group A and group B randomly. Group A （ 25 patients ） were administrated by venous injection of milrinone with a dose of 0. 5 ug / （ kg·min） for 5 days;group B （20 patients） were administrated by venous injection of dopamine with a dose Of 5ug/ （ kg ·min） for 5 days. Observe the clinical effect and the change of some hemodynamics in group using milrinone, such as pulmonary artery blood flow related to systemic blood flow（ Qp/Qs ） ,left cardiac index of ventricle （ LV-CI ） , cardiac index of right ventricle （ RV-CI ） , pulmonary arterial systolic pressure （ PASP ）, heart rate （ HR ） and systolic blood pressure （ SBP ）, and compare with the group using dopamine. Results After using milrinone for 5 days, the clinical manifestation and physical sign of patients in group A had remarkable improvement （ P 〈 0. 05 ） , and the PASP and Qp/Qs were significantly lower while LV-CI was higher （ P 〈 0. 05 ） , and the heart rate and blood pressure had unremarkable change （ P 〉 0. 05）. The total effect rate of milrinone reached 92. 0%, and the total effect rate in group B only reached 75.0% ; the improvement of hemodynamics was not obvious （ P 〉 0. 05 ）. The difference of clinical effect and the hemodynamics after the therapy between group A and B was of statistical significance （ P 〈 0. 05 ）. Conclusion Milrinone has positive inotropic and vasodilator activity,which has the function of selective dilation of pulmonary vascular bed,can improve the cardiorespiratory function and reduce pulmonary artery pressure obviously in children severe congenital heart disease （ CHD） with pulmonary hypertension （ PH） ;however, it dose not change the heart rate and blood pressure.

关 键 词：米力农 先天性心脏病 肺动脉高压 血液动力学 儿童 

分 类 号：R72[医药卫生—儿科]