Efficacy of olprinone on refractory heart failure in patients with chronic pulmonary heart disease
Objective To observe the changes of cardiac function,pulmonary function,heart rate variability and composite index of myocardial function in patients with refractory heart failure with chronic pulmonary heart disease before and after treatment with olprinone,and to investigate the therapeutic efficacy and safety.Methods From January 2019 to July 2020,109 patients with refractory heart failure with chronic pulmonary heart disease were diagnosed and treated in Henan Electric Power Hospital.On the basis of conventional treatments such as oxygen intake,fluid intake control,diuresis,cardiotonicity,anti-infection,vasodilatation,correction of water-electrolyte disorders and acid-base imbalance,all patients were pumped with 10 μg/kg oprylonium hydrochloride within 5 min,followed with 0.1 to 0.3 μg/(kg·min)for maintenance,and 0.4 μg/(kg·min)if necessary,with the total dose of 0.6 mg/kg or below in 24 h.Non-invasive ventilation was performed if necessary.The efficacy was evaluated after 7-d treatment.The serum interleukin(IL)-6,IL-1β,tumor necrosis factor-α(TNF-α),maximal expiratory flow(PEF),forced vital capacity(FVC),forced expiratory volume in one second(FEV1)/FVC,6-min walking test(6MWT)distance,standard deviation of normal R-R intervals(SDNN),percentage of adjacent RR intervals differing by more than 50 ms(pNN50),standard deviation of average 5-min normal R-R intervals(SDANN),root mean square of successive R-R intervals differences(rMSSD),and the composite index of myocardial function were compared before and after treatment.The patients were followed up for 6 months to record the major adverse cardiac events.Results(1)Among the 109 patients,54 received non-invasive mechanical ventilation,and were discharged after(15.23±4.02)d of hospital stay.The 7-d treatment result was significantly effective in 51 patients,effective in 28,and ineffective in 30,with the total effective rate of 72.48％.(2)The levels of serum IL-6,IL-1β,TNF-α and myocardial function composite index were lower after 7-d treatment[(12.10±2.18)ng/L,(0.17±0.03)μg/L,(5.53±1.87)mg/L,0.37±0.11]than those before treatment[(35.75± 5.63)ng/L,(0.37±0.09)μg/L,(14.55±3.14)mg/L,0.93±0.12](P＜0.05),PEF,FVC,FEV1/FVC,SDNN,pNN50,SDANN and rMSSD were higher after 7-d treatment[(4.78±0.34)L/s,(2.85±0.12)L,(73.78±2.35)％,(109.37±3.46)ms,(4.39±0.22)％,(80.95±4.20)ms,(32.59±2.98)ms]than those before treatment[(3.35± 0.42)L/s,(2.09±0.13)L,(51.65±1.98)％,(77.55±3.59)ms,(3.09±0.15)％,(66.17±3.87)ms,(22.55± 1.42)ms](P＜0.05),and 6MWT distance was longer after 7-d treatment[(402.51±34.65)m]than that before treatment[(237.15±34.58)m](P＜0.05).(3)During the follow-up period,10 patients were re-hospitalized due to heart failure,3 developed malignant arrhythmia,2 developed cardiac death,and the incidence of major adverse cardiac events was 13.76％.Conclusion The application of olprinone in addition to the conventional treatments has a good short-term efficacy on refractory heart failure and pulmonary heart disease,since it can reduce the inflammatory response,store cardiopulmonary function,correct heart rate variability,and reduce the incidence of major adverse cardiac events.
pulmonary heart diseaserefractory heart failureolprinonecardiac functionpulmonary functionheart rate variabilitymyocardial function composite index
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