正性肌力药物在心衰治疗策略中的临床应用及地位课件.ppt

LCRs---基因座控制区 Iloprost---伊洛前列素 Lambs---小羊 PPHN--persistent pulmonary hypertension of newborn]新生儿持续性肺动脉高压 1不能改善已坏死心肌 2.可通过改善血流动力学而改善心输出量。3、降低BNP水平；4、对肌红肌钙没有明显水平；5、减少炎性因子和细胞凋亡信号的表达。 * 14例缺血性心肌病伴LVEF30%、LVESVI100ml/m2行CABG术前给予米力农以0.5ug/kg/ml持续泵入治疗后结果： LVEDD 26.3mmHg降至15.4mmHg 左室早期舒张充盈率/动脉充盈率 4.5降至2.1 血流动力学趋于稳定 与对照组比术后多巴酚丁胺及去甲肾上腺素用量明显减少 Ann Thorac Cardiovasc Surg 2009;15:233-238 负荷量注射后对血浆激素水平的影响 表明米力农具有强心和扩血管作用。同时可降低血管紧张素Ⅱ、内皮素、心钠素水平。其机理可能是随着心衰和血液动力学改善而改变。 The Effect of Milrinone on Platelet Activation asDetermined by TEG? Platelet Mapping? 2009 International Anesthesia Research Society Vol. 108, No. 5, May 2009 CONCLUSIONS: Therapeutic blood concentrations of milrinone exhibit a significant inhibitory effect on ADP and AA-induced platelet activation as determined by TEG Platelet Mapping, without affecting the conventional kaolin-activated TEG. We suggest that TEG Platelet Mapping results be interpreted with caution in patients being treated with milrinone, and other drugs that modify platelet cyclic nucleotide concentrations. Milrinone for the Treatment of Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage Stroke. 2008;39:893-898 Methods—Twenty-two consecutive patients with angiographically-proven CVS (arterial diameter reduction 40%). Intraarterial milrinone was infused in the cerebral territory(ies) involved and followed by continuous intravenous infusion until Day 14 after initial bleeding. We evaluated angiographic reversal of CVS, hemodynamic tolerance, and neurological outcome 1 year after aSAH. Conclusion—This study suggests that milrinone is effective and safe for reversal of CVS after aSAH Constitutive Phosphodiesterase Activity Restricts Spontaneous Beating Rate of Cardiac Pacemaker Cells by Suppressing Local Ca2+ Releases Circ Res. 2008 Apr 11;102(7):761-9.  Figure 1. Suppression of PDE activity in SANCs dramatically increases cAMP and spontaneous beating rate. Figure 2. A comparison of relative