【摘要】 目的 比较不同剂量米力农治疗终末期顽固性心力衰竭患者的疗效。方法 选取2020年1月—2021年6月北京市昌平区医院心内科收治的终末期顽固性心力衰竭患者120例，采用随机数字表法分为对照组40例、大剂量组40例及小剂量组，各40例。对照组患者采用常规药物治疗，大剂量组患者在对照组基础上予以米力农注射液10 mg静脉泵注，小剂量组患者在对照组基础上给予米力农注射液0.5μg·kg^-1·min^-1泵点给药。3组均持续治疗7 d。比较3组临床疗效、症状缓解时间、住院时间、1年再入院率、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、N末端脑钠肽前体（NT-proBNP）水平、6 min步行距离，并观察3组不良反应发生情况及1年内不良心血管事件发生情况。结果 小剂量组总有效率高于对照组（χ²=12.624,P<0.001）,大、小剂量组间比较差异无统计学意义（χ²=2.857,P=0.091）。3组1年内再入院率比较，差异无统计学意义（P>0.05）。大剂量组、小剂量组症状缓解时间、住院时间均短于对照组（P<0.01）。治疗7 d后，大剂量组、小剂量组LVEDD、LVESD小于对照组，LVEF高于对照组，NT-proBNP水平低于对照组，6 min步行距离长于对照组（P<0.01）,但大剂量组与小剂量组各指标组间比较差异无统计学意义（P>0.05）。3组治疗期间不良反应总发生率、1年内不良心血管事件总发生率比较，差异无统计学意义（P>0.05）。结论 与大剂量米力农比较，在常规药物治疗基础上加用小剂量米力农治疗终末期顽固性心力衰竭患者可增强疗效，且可迅速缓解患者的临床症状，改善患者的心功能，减轻心肌损伤，提高运动耐量，且患者预后较好，安全性较高。更多还原

【Abstract】 Objective To compare the effect of different doses of milrinone in the treatment of patients with end-stage refractory heart failure. Methods A total of 120 patients with end-stage refractory heart failure hospitalized in the Department of Cardiovascular Medicine of Beijing Changping Hospital from January 2020 to June 2021 were selected, and they were divided into the control group（40 cases）, the low-dose group（40 cases） and the high-dose group（40 cases） by random number table method. The control group was treated with conventional drugs, the high-dose group was additionally given 10 mg of milrinone injection for intravenous pump injection, and the low-dose group was additionally given 0.5 μg·kg^-1·min^-1 of milrinone injection for pump point administration. All groups were treated for 7 days. Clinical efficacy, symptom improvement time, length of stay, 1-year readmission rate, LVEDD, LVESD, LVEF, NT-proBNP level and 6 min walking distance among the three groups were compared, and the occurrence of adverse reactions and adverse cardiovascular events within 1-year among the three groups were observed. Results The total effective rate of the low-dose group was higher than that of the control group（χ²=12.624, P<0.001）, but there was no significant difference between the high-dose group and the low-dose group（χ²=2.857, P=0.091）. There was no significant difference of 1-year readmission rate among the three groups（P>0.05）. The high-dose group and the low-dose group of symptom improvement time, length of stay were shorter than those of the control group（P<0.01）. After 7 days of treatment, the LVEDD、 LVESD of the high-dose group and the low-dose group were less than those of the control group, LVEF were higher than those of the control group, NT-proBNP level were lower than those of the control group, 6 min walking distance were longer than those of the control group（P<0.01）, but there was no significant difference of the above indexes between the high-dose group and the low-dose group（P>0.05）. There was no significant difference of occurrence of adverse reactions during treatment and adverse cardiovascular events within 1-year among the three groups（P>0.05）. Conclusion Compared with high-dose of milrinone, conventional drug therapy plus low-dose of milrinone can enhance the efficacy for patients with end-stage refractory heart failure, it can rapidly alleviate the clinical symptoms of patients, improve the cardiac function, reduce myocardial damage, improve exercise tolerance, and with good prognosis and high safety.更多还原