Résumé
Objective To investigate the clinical effect and safety of continuous intravenous pumping of sodium nitroprusside and dopamine on treating elderly patients with refractory heart failure. Methods Two hundred and seventy elderly patients with refractory heart failure were selected as our subjects and they were randomly divided into sodium nitroprusside group,dopamine group and the combined group( 90 cases for each group). All the patients were given the corresponding symptomatic treatment,including oxygen,diuretics, angiotensin converting enzyme inhibitors,digitalis,aldosterone receptor antagonist,etc. Patients in sodium nitroprusside group,dopamine group were treated sodium nitroprusside or dopamine respectively,and patients in combined group were given both of sodium nitroprusside and dopamine by continuous intravenous pumping. Serum brain natriuretic peptide( BNP ),left ventricular ejection fraction( LVEF ),LV end systolic volume index(LVESVI),left ventricular end diastolic volume index(LVEDVI),left ventricular diastolic early, late filling velocity ratio( E/A ),mean arterial pressure and heart rate( HR ) level were measured or recorded. Results The levels of BNP,LVEF,LVESV,LVEDV,E/A,mean arterial pressure and the level of HR among three group before treatment were no significant differences( F =4. 000,1. 434,0. 503,3. 622,3. 589, 4. 135,2. 752;P﹥0. 05). After treatment,the levels of BNP,LVEF,LVESV,LVEDV and HR in combined group were(201. 6 ±66. 8)pg/L,(45 ± 4)%,(29. 8 ± 4. 8)ml/m2,(45. 1 ± 7. 3)ml/m2,(73. 2 ± 11. 2)times/min,in sodium nitroprusside group were( 298. 6 ± 75. 3 ) pg/L,( 37 ± 4 )%,( 35. 5 ± 4. 6 ) ml/m2 ,( 51. 8 ±7.5)ml/m2,(92.9 ±11.5)times/min,and in dopamine group were(293.7 ±78.2)pg/L,(37 ±3)%, (35. 6 ± 5. 8)ml/m2,(52. 1 ± 7. 3)ml/m2,(93. 6 ± 12. 3)times/min respectively,and the differences were significant(F=41. 683,129. 400,43. 600,28. 800,328. 600;P﹤0. 05). The total effective rate in combination group was 97. 8%( 88/90 ),significantly higher than that of sodium nitroprusside group( 86. 7%,8/90 ) or dopamine group( 88. 9%,80/90 ),and the differences were statistically significant(χ2 =7. 683,P ﹤0. 05). There were 3 cases(3. 3%)with adverse reaction in combination group after treatment,including 1 cases of headache and 2 cases of nausea and vomiting. All above symptoms disappeared after stopping drugs. There was 1 cases(1. 1%)with adverse reaction in sodium nitroprusside group,1 cases(1. 1%)in dopamine group,and there was no significant differences seen among three groups(χ2 =1. 630,P﹥0. 05). Conclusion Continuous intravenous infusion of sodium nitroprusside combined with dopamine on cardiac function in elderly patients with refractory heart failure can improve clinical effect and enhance the medication security.
Résumé
Introduction: Infantile Hepatic hemangioendothelioma is characterized by multifocal benign vascular dilatations involving the liver. The clinical course depends on tumor size, localization and complications. Case Report: 15 days old neonate with stormy postnatal period was referred for intractable congestive cardiac failure. Transthoracic 2D echocardiography showed multiple vegetations on all the four valves, noncompaction of left ventricle with multiple vascular channels in left lobe of liver. Computed tomography angiogram showed 58x29x50 mm markedly enhancing lesion in left lobe of liver suggestive of infantile hepatic hemangioendothelioma. The neonate was treated for bacterial endocarditis. Later 6x6 Amplatzer duct occluder II was parked in hepatic vein, then gel foam and polyvinyl chloride particles were injected into infantile hepatic hemangioendothelioma. Cardiac failure resolved with marked regression of lesion. Discussion: Infantile hepatic hemangioendothelioma is a rare anomaly causing heart failure in neonate causing death in up to 70% of untreated infants without adequate regression of lesion. Therefore aggressive treatment is warranted. For the first time in the world, we report a case of infantile hepatic hemangioendothelioma in a neonate, with pump failure due to noncompaction of left ventricle and vegetations on all four valves, successfully treated by combination of transcatheter deployment of Amplatzer duct occluder II to occlude the venous end and hand injection of gel foam and polyvinly chloride particles from the aortic end to close the feeder artery. Conclusion: The combination of closure of hepatic vein by Amplatzer duct occluder II and injection of gel foam and polyvinyl chloride particles is safe and effective in infantile hepatic hemangioendothelioma in neonate with heart failure.