INTRAVENOUS MILRINONE AND ENALAPRIL IN PATIENTS WITH ADVANCED HEART FAILURE

功能分级，频繁失代偿，左心室射血 左室射血分数（LVEF），心脏血流动力学，峰值运动耗氧量 (peak VO 2）和神经激素异常对患者的预后有价值 严重心力衰竭在我们的中心，这些参数被测量 在晚期心力衰竭患者中， 心脏衰竭和心脏移植医疗需要。如果 预后指标较差，心脏血流动力学参数 右心导管检查结果明显异常， 在冠心病监护室接受强化治疗， 静脉输注正性肌力药/血管扩张剂米力农，以改善 血流动力学和临床状态。 静脉注射米力农是磷酸二酯酶抑制剂， 正性肌力作用以及外周和肺血管舒张作用 并导致心输出量增加，肺毛细血管楔减少 血压、全身血管阻力降低和心脏改善 故障症状静脉输注米力农后，口服 血管紧张素转换酶抑制剂（ACE）扩张血管治疗 和/或肼苯哒嗪/硝酸盐组合滴定至治疗剂量 和口服利尿剂在右心导管引导下进行优化， 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.