EVALUATION OF A NEW BIPYRIDINE INOTROPIC AGENT - MILRINONE - IN PATIENTS WITH SEVERE CONGESTIVE HEART-FAILURE
EVALUATION OF A NEW BIPYRIDINE INOTROPIC AGENT - MILRINONE - IN PATIENTS WITH SEVERE CONGESTIVE HEART-FAILURE
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DOI：
10.1056/nejm198309293091302
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发表时间：
1983-01-01
影响因子：
158.5
通讯作者：
GROSSMAN, W
中科院分区：
文献类型：
--
作者：
BAIM, DS;MCDOWELL, AV;GROSSMAN, W
米力农是氨力农的衍生物，其变力效力是母体化合物的近20倍，对正常志愿者或对氨力农敏感的动物不会引起发烧或血小板减少症。在20例严重充血性心力衰竭患者中，静脉注射。米力农使左室舒张末压显著降低(从27.0±-.2至18.+-2 mm Hg)、肺楔压、右心房压和体循环阻力，平均动脉压略有下降。心脏指数显著增加(从1.9。+-。0.1至2.9。+-。0.2Min/m~2)，左心室内压正一阶导数达峰值，心率略有增加。在24小时持续输液期间，血流动力学持续改善。在20名患者中，19名患者随后接受了口服米力农(29。+-)。2毫克/天)，最多11个月。(平均值为6.0.+-。0.8)，心力衰竭症状持续改善。在10名接受长期口服米力农(gtoreq.6个月)，放射性核素心室造影术显示持续的反应，在7.5 mg药物后，左心室射血分数增加了27%。平均4.8个月后死亡4例。3名患有严重潜在冠状动脉疾病和心绞痛的患者需要额外的抗心绞痛治疗。无发热、血小板减少、胃肠耐受或室性异位加重。米力农显示出长期治疗充血性心力衰竭的希望。
Milrinone, a derivative of amrinone, has nearly 20 times the inotropic potency of the parent compound and does not cause fever or thrombocytopenia in normal volunteers or in animals sensitive to amrinone. In 20 patients with severe congestive heart failure, i.v. milrinone resulted in significant decreases in left ventricular end-diastolic pressure (from 27 .+-. 2 to 18 .+-. 2 mm Hg), pulmonary wedge pressure, right atrial pressure and systemic vascular resistance, as well as a slight reduction in mean arterial pressure. Significant increases occurred in cardiac index (from 1.9 .+-. 0.1 to 2.9 .+-. 0.2 l/min per m2) and the peak positive 1st derivative of left ventricular pressure, with a slight increase in heart rate. Hemodynamic improvement was sustained during a 24-h continuous infusion. Of the 20 patients, 19 subsequently received oral milrinone (29 .+-. 2 mg/day) for up to 11 mo. (mean, 6.0 .+-. 0.8), with sustained improvement in symptoms of heart failure. In 10 patients receiving long-term oral milrinone (.gtoreq. 6 mo.), radionuclide ventriculography showed continued responsiveness, with a 27% increase in left ventricular ejection fraction after 7.5 mg of the drug. Patients (4) died after a mean of 4.8 mo. of therapy, and 3 patients with severe underlying coronary-artery disease and angina pectoris required additional antianginal therapy. No patient had fever, thrombocytopenia, gastrointestinal intolerance or aggravation of ventricular ectopy. Milrinone shows promise for the long-term treatment of congestive heart failure.