米力农和多巴酚丁胺用于治疗心源性休克的比较

心源性休克与病人发病率和死亡率密切相关。虽然正性肌力支持是心源性休克的主要药物治疗方法，临床上用于指导正性肌力药物选择的依据很少。

我们以双盲的方式随机将心源性休克患者分配接受米力农或多巴酚丁胺治疗。主要观察指标是任何原因引起的住院死亡，复苏后的心跳骤停，接受心脏移植或机械循环支持，非致死性心肌梗死，神经科医师诊断的短暂性脑缺血或中风，或开始肾脏替代治疗等一系列的组成。次要观察指标包括主要复合结果的各个组成部分。

总共招募了192个参与者（每组96个）。治疗组的主要结局没有显著差异。主要观察指标米力农组47名参与者（49%）和多巴酚丁胺组52名参与者（54%）（相对风险，0.90；95%置信区间[CI]，0.69至1.19；P=0.47）。两组之间的次要结局也没有显著差异，包括住院死亡（分别为37%和43%；相对风险，0.85；95%CI，0.60至1.21）、复苏后心脏骤停（7%和9%；危险比，0.78；95%CI，0.29CI至2.07）、接受机械循环支持（12%和15%；危险比，0.78；95%CI，0.3%至1.71）或开始肾替代治疗（22%和17%；危险比，1.39；95%CI，0.73至2.67）。

在心源性休克患者中，米力农和多巴酚丁胺在主要观察指标或重要的次要观察指标方面没有发现显著差异。

Rebecca Mathew, Pietro Di Santo, Richard G. Jung, et al. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock.[J].n engl j med, N Engl J Med 2021;385:516-25.

Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock

Abstract

Background: Cardiogenic shock is associated with substantial morbidity and mortality. Although inotropic support is a mainstay of medical therapy for cardiogenic shock, little evidence exists to guide the selection of inotropic agents in clinical practice.

Method:We randomly assigned patients with cardiogenic shock to receive milrinone or dobutamine in a double-blind fashion. The primary outcome was a composite of in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke diagnosed by a neurologist, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite outcome.

Results:A total of 192 participants (96 in each group) were enrolled. The treatment groups did not differ significantly with respect to the primary outcome; a primary outcome event occurred in 47 participants (49%) in the milrinone group and in 52 participants (54%) in the dobutamine group (relative risk, 0.90; 95% confidence interval [CI], 0.69 to 1.19; P=0.47). There were also no significant differences between the groups with respect to secondary outcomes, including in-hospital death (37% and 43% of the participants, respectively; relative risk, 0.85; 95% CI, 0.60 to 1.21), resuscitated cardiac arrest (7% and 9%; hazard ratio, 0.78; 95% CI, 0.29 to 2.07), receipt of mechanical circulatory support (12% and 15%; hazard ratio, 0.78; 95% CI, 0.36 to 1.71), or initiation of renal replacement therapy (22% and 17%; hazard ratio, 1.39; 95% CI, 0.73 to 2.67).

Conclusion:In patients with cardiogenic shock, no significant difference between milrinone and dobutamine was found with respect to the primary composite outcome or important secondary outcomes.