Orime Y, Shiono M, Hata H, Yagi S, Tsukamoto S, Okumura H, Kimura S, Hata M, Sezai A, Obana M, Sezai Y
The Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
Jpn Circ J. 1999 Feb;63(2):117-22. doi: 10.1253/jcj.63.117.
The aim of this study was to estimate the postoperative effects of phosphodiesterase (PDE) inhibitors (milrinone and olprinone) after coronary artery bypass grafting (CABG). To prevent hypotension caused by the PDE inhibitors, low dose of catecholamines were used concomitantly. A total of 34 elective CABG cases were tested. In 12 cases, 0.25 microg kg(-1) min(-1) of milrinone, 3 microg kg(-1) min(-1) of dobutamine (DOB) and dopamine (DOA) were used concomitantly (Group-M). In another 10 patients, 0.1 microg kg(-1) min(-1) of olprinone and the same doses of the catecholamines were infused (Group-O). As a control, the same doses of DOA and DOB only were administered in 12 patients (Group-C). When the pump flow of the cardiopulmonary bypass (CPB) decreased to half, these drugs were given in all groups. Hemodynamics were recorded before CPB, just after the operation, and 3, 6, 12, 24, 48 and 72 h after the operation. Both milrinone and olprinone increased the cardiac index and decreased systemic vascular resistance to almost the same degree. Olprinone decreased mean aortic and pulmonary artery pressures, and also significantly reduced the preload of both right and left heart compared with milrinone. Significant hypotension was not detected due to the concomitant usage of low-dose catecholamines. This concomitant usage of PDE inhibitors and catecholamines allowed easy weaning from CPB, demonstrating excellent hemodynamics after CABG. Good oxygen demand and supply balance were maintained in peripheral tissue. These results suggest that these new PDE inhibitors may be effective not only for weaning from CPB but also for post-cardiotomy cardiogenic shock.
本研究的目的是评估磷酸二酯酶（PDE）抑制剂（米力农和奥普力农）在冠状动脉旁路移植术（CABG）后的术后效果。为预防PDE抑制剂引起的低血压，同时使用了低剂量的儿茶酚胺。总共对34例择期CABG病例进行了测试。在12例病例中，同时使用了0.25微克/千克/分钟的米力农、3微克/千克/分钟的多巴酚丁胺（DOB）和多巴胺（DOA）（M组）。在另外10例患者中，输注了0.1微克/千克/分钟的奥普力农和相同剂量的儿茶酚胺（O组）。作为对照，仅对12例患者给予相同剂量的DOA和DOB（C组）。当体外循环（CPB）的泵流量降至一半时，所有组均给予这些药物。记录了CPB前、术后即刻以及术后3、6、12、24、48和72小时的血流动力学数据。米力农和奥普力农均使心脏指数增加，全身血管阻力降低，程度几乎相同。与米力农相比，奥普力农降低了平均主动脉压和肺动脉压，还显著降低了左右心的前负荷。由于同时使用低剂量儿茶酚胺，未检测到明显的低血压。PDE抑制剂与儿茶酚胺的这种联合使用使CPB撤机容易，显示出CABG术后良好的血流动力学。外周组织维持了良好的氧供需平衡。这些结果表明，这些新型PDE抑制剂不仅可能对CPB撤机有效，而且对心脏术后心源性休克也有效。
