Wright E M, Skoyles J, Sherry K M
Department of Anaesthesia, Northern General Hospital, Sheffield, United Kingdom.
Eur J Anaesthesiol Suppl. 1992;5:21-6.
Milrinone is known to have beneficial haemodynamic and clinical effects in patients with congestive heart failure. An investigation into the safety and efficacy of milrinone in patients following heart surgery was undertaken by the European Milrinone Multicentre Trial Group. This paper reports the efficacy, the effects on left heart function, and the adverse events in the study. Ninety-nine adult patients, 61 coronary artery bypass grafting (CABG), 33 valve surgery (VS), and five CABG+VS were studied. Three dosage regimens were investigated sequentially. All patients received a loading dose of intravenous milrinone 50 micrograms kg-1 over 10 min, followed by an infusion of either 0.375 micrograms kg-1 min-1, 0.5 microgram kg-1 min-1, or 0.75 microgram kg-1 min-1 over 12 h. The groups were comparable for age, weight, and surface area; however, in the group receiving 0.5 microgram kg-1 min-1 there were more females and patients undergoing mitral valve surgery. Efficacy criteria of an increase in cardiac index of 30% and/or a decrease in mean pulmonary capillary wedge pressure of 25% were fulfilled by 77 patients at the 60-min measurement. Of the remaining 22 patients, 17 were clinically satisfactory and fulfilled efficacy criteria at some time during the study. At 15 min and 60 min there was a dose-related decrease in systolic and diastolic arterial pressure; however, there was no significant difference in the mean arterial pressure measurements. In all groups there was an improvement in cardiac index at 15 min following the start of milrinone, which was sustained during and up to 4 h after the infusion. This was closely associated with changes in stroke volume index and systemic vascular resistance, and not solely due to a change in heart rate.
已知米力农对充血性心力衰竭患者具有有益的血流动力学和临床效果。欧洲米力农多中心试验组对米力农在心脏手术后患者中的安全性和有效性进行了一项调查。本文报告了该研究中的疗效、对左心功能的影响以及不良事件。研究了99例成年患者，其中61例行冠状动脉旁路移植术（CABG），33例行瓣膜手术（VS），5例行CABG + VS。依次研究了三种给药方案。所有患者先在10分钟内静脉注射负荷剂量的米力农50微克/千克，然后在12小时内输注0.375微克/千克·分钟、0.5微克/千克·分钟或0.75微克/千克·分钟。各组在年龄、体重和体表面积方面具有可比性；然而，接受0.5微克/千克·分钟的组中女性和接受二尖瓣手术的患者较多。在60分钟测量时，77例患者达到了心脏指数增加30%和/或平均肺毛细血管楔压降低25%的疗效标准。在其余22例患者中，17例在研究期间的某个时间临床情况令人满意并达到了疗效标准。在15分钟和60分钟时，收缩压和舒张压呈剂量相关下降；然而，平均动脉压测量值无显著差异。在所有组中，米力农开始输注后15分钟时心脏指数均有改善，在输注期间及输注后4小时内一直维持。这与每搏量指数和全身血管阻力的变化密切相关，而不仅仅是由于心率的变化。
