重症左心不全に対するアムリノンならびにミルリノン静脈内投与における急性効果の比較検討

Comparative Efficacy of Short-Term Intravenous Infusion of Amrinone and Milrinone in Patients with Severe Congestive Heart Failure

　アムリノン（A群）ならびにミルリノン（B群）の血行動態に及ぼす急性効果をNYHAIII度以上の重症心不全15例（男性9例，女性6例，平均年齢65±14歳）を対象に検討した．投与方法は，A群1mg／kg静注後10μg／kg／minの持続点滴，B群50μg／kg静注後0.5μg／kg／minの持続点滴を施行した．以下，投与1時間後ならびに投与24時間後の心拍数，収縮期血圧，拡張期血圧，肺動脈楔入圧，心係数を投与前値の％変化率で算出し，両群間での各指標を比較した．A群ならびにB群における投与1時間後ならびに投与24時間後の心拍数，収縮期血圧，拡張期血圧，肺動脈楔入圧の％変化率に有意差を認めなかったが，投与1時間後ならびに24時間後の心係数の％変化率は，それぞれA群16.4±15.3％，17.0±10.8％，B群27.3±10.3％，24.7±10.3％であり，A群に比しB群で高値であった（p＜0.05,A群vsB群）．ミルリノンはアムリノンに比しより強力な陽性変力作用を有する薬剤であることが示唆された．

The effects of amrinone (group A) and milrinone (group B) were compared in 15 patients ( 9 male6female;average age 65±14 years) with functional classIII and IV congestive heart failure ( grading according tothe New York Heart Association) In group A amrinonewas administered intravenously as a drip infusion(10μ9/kg/min) after a bolus injection (lmg/kg). Ingroup B milrinone was administered intravenously as adrip infusion ( 0.5μg/kg/min) after a bolus injection( 50μg/kg).The following mesurements were made at lhour and 24 hours after administration;heart rate;brachial artery systolic and diastolic blood pressure;pulmonary capillary wedge pressure;and cardiacindex. There was no significant difference in the percentchanges in heart rate systolic blood pressure diastolicblood pressure and pulmonary capillary wedge pressurebetween group A and group B. However the percentchange in cardiac index from baseline was significantlyhigher in group B than in group A ( 27.3±10.3%vs 16.4±15.3% at l hour and 24.7±10.3%vs 17.O±10.8% at 24hours;mean±SD;both p＜0.05) The results of thisstudy indicate that inotropic milrinone produces a morepotent inotropic effect than amrinone in cases of severecongestive heart faiure.