INTRAVENOUS MILRINONE AND ENALAPRIL IN PATIENTS WITH ADVANCED HEART FAILURE

功能分级、频发失代偿、左心室射血分数(LVEF)、心脏血流动力学、最大运动耗氧量(峰值VO2)和神经激素异常对晚期心力衰竭患者有预后价值。在我们的中心，这些参数是在转诊为晚期心力衰竭的患者中测量的，以评估心力衰竭的严重程度和心脏移植的医疗需求。如果孕激素指标差，右心插管测量的心脏血流动力学参数明显异常，患者将在冠脉监护病房接受强化治疗，48至72小时静脉滴注肌力调节剂/血管扩张剂米力农，以改善血流动力学和临床状态。静脉注射米力农是一种磷酸二酯酶抑制剂，既有正性肌力作用，也有外周和肺血管扩张作用，结果是增加心输出量，降低肺毛细血管楔压，降低全身血管阻力，改善心力衰竭症状。静脉滴注米力农后，口服血管扩张剂血管紧张素转换酶抑制剂(ACE)和/或肼丙嗪/硝酸盐联合治疗剂量滴定至治疗量，并在右心导管引导下优化口服利尿剂，以维持改善的血流动力学和临床状态。

Functional class, frequent decompensations, left ventricular ejection fraction (LVEF), cardiac hemodynamics, peak exercise oxygen consumption (peak VO2), and neurohormonal aberration have prognostic value in patients with advanced heart failure. At our center, these parameters are measured in patients referred with advanced heart failure to assess severity of heart failure and medical need for cardiac transplantation. If progonostic indicators are poor and cardiac hemodynamic parameters as measured by right heart catheterization are markedly abnormal, patients undergo intensive treatment in the Coronary Care Unit with a 48 to 72 hour intravenous infusion of the inotrope/vasodilator milrinone, to improve hemodynamics and clinical status. Intravenous milrinone is a phosphodiesterase inhibitor that has both positive inotropic as well as peripheral and pulmonary vasodilatory effects and results in increase cardiac output, decreased pulmonary capillary wedge pressure, decreased systemic vascular resistance and improvement in heart failure symptoms. After intravenous milrinone infusion is completed, oral vasodilator therapy with angiotensin converting enzyme inhibitors (ACE) and/or hydralazine/nitrate combination are titrated to therapeutic doses and oral diuretics are optimized under right heart catheter guidance to maintain the improved hemodynamic and clinical status.