Intermittent Inotropic Infusions Combined With Prophylactic Oral Amiodarone for Patients With Decompensated End-stage Heart Failure
Intermittent Inotropic Infusions Combined With Prophylactic Oral Amiodarone for Patients With Decompensated End-stage Heart Failure
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DOI：
10.1097/fjc.0b013e31819846cd
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发表时间：
2009-02-01
影响因子：
3
通讯作者：
Nanas, John N.
中科院分区：
文献类型：
--
作者：
Drakos, Stavros G.;Kanakakis, John V.;Nanas, John N.
背景：人们对慢性间歇静脉正性肌力药治疗终末期慢性心力衰竭患者的死亡率和伦理学提出了关注。我们研究了间歇肌力药联合口服胺碘酮预防肌力药致心律失常的效果。方法：162例失代偿期慢性心力衰竭患者，首次静脉滴注肌力药物72小时即可脱机。第1组：140例患者，每周间歇静脉注射正性肌力药加口服胺碘酮，每日2次，每次200 mg，疗程6个月。结果：两组患者的基线特征包括纽约心脏协会功能分级(两组均为IV级)、入院时动脉收缩压(99.14对97.13 mm Hg)、右房压(13+/-6vs.14+/-6 mm Hg)、肺毛细血管楔压(28+/-7vs.31.10 mm Hg)、血钠(136.0mEq/-7vs.139+/-6mEq/L)和血肌酐(1.7mEq/-0.8vs.1.8+/1.8mgdL)，相似。6个月期(51%对18%)和一年期(36%对18%)两组存活率差异均有统计学意义(P=0.001)。另外，间歇静脉正性肌力药治疗改善了患者的功能和血流动力学状态。结论：间歇静脉正性肌力药联合预防性口服胺碘酮可改善终末期慢性心力衰竭患者的预后。需要进一步的研究来阐明这种治疗策略是否应该被认为是难治性终末期心力衰竭患者的标准治疗方法。
Background: Concern has been raised regarding the mortality and ethics related to the treatment of patients with end-stage chronic heart Failure with chronic intermittent intravenous inotropic agents. We examined whether intermittent inotropic agents combined with oral amiodarone to prevent the proarrhythmic effect of inotropic agents results in better outcomes.Methods: The study included 162 patients with decompensated end-stage chronic heart failure, who could be weaned from an initial 72-hour infusion of intravenous inotropes. Group 1 included 140 patients, who entered a 6-month program of weekly intermittent intravenous inotropic agents plus oral amiodarone, 200 mg twice a day. Group 2 included 22 patients, who were treated with optimal conventional therapy and were hospitalized for administration of intravenous medications as needed.Results: The baseline characteristics of groups I versus 2, including New York Heart Association functional class (IV in both groups), admission systolic arterial blood pressure (99 14 vs. 97 13 mm Hg), right atrial pressure (13 +/- 6 vs. 14 +/- 6 mm Hg), pulmonary capillary wedge rircssure (28 +/- 7 vs, 31 10 mm Hg), serum sodium (136 +/- 7 vs. 139 +/- 6 mEq/L) and scrum creatinine (1.7 +/- 0.8 vs. 1.8 +/- 1.8 mg/dL.), wen., similar. The 6-month (51% vs. 18%) and 1-year (36% VS. 9%) survival rates were significantly higher (P = 0.001 for both) in group 1 than in group 2. In addition, patients treated with intermittent intravenous inotropic agents improved their functional and hemodynamic status.Conclusions: intermittent intravenous inotropic agents combined with prophylactic oral amiodarone seem to improve the outcomes of patients with end-stage chronic heart failure. Further research is warranted to elucidate whether this treatment strategy should be considered as a standard therapy in patients with refractory end-stage heart failure.