Harris M N, Daborn A K, O'Dwyer J P
St Thomas' Hospital, London, United Kingdom.
Eur J Anaesthesiol Suppl. 1992;5:27-30.
In a multicentre study of 99 adult patients undergoing cardiac surgery, if post-operative cardiac failure was demonstrated (pulmonary capillary wedge pressure greater than 8 mmHg, cardiac index less than 2.5 litre min-1 m-2), then a bolus dose of milrinone (50 micrograms kg-1) was given, followed by an infusion at one of three rates (0.375, 0.5 or 0.75 microgram kg-1 min-1), and haemodynamic effects were assessed. Mean pulmonary artery pressures fell by 15% initially (P less than 0.001), and this significant reduction was maintained throughout the infusion period and reversed with the withdrawal of milrinone. Mean pulmonary vascular resistance fell progressively throughout the infusion period, the maximum change (30-40%) being evident at the 12 h point (P less than 0.05). Reversal of this effect after terminating the milrinone infusion was less marked than with pulmonary capillary wedge pressure or mean pulmonary artery pressure. A group of 39 of these patients from two centres were retrospectively divided into three groups: 1. Mitral valve replacement with high baseline pulmonary vascular resistance (greater than 200 dyne s cm-5) 2. Coronary revascularization with lower baseline pulmonary vascular resistance (100-200 dyne s cm-5) 3. Coronary revascularization with high baseline pulmonary vascular resistance (greater than 200 dyne s cm-5). There was a significant reduction in pulmonary vascular resistance and increase in cardiac index in all patients. At the 15 min point, there was significant between-group variation, the fall in pulmonary vascular resistance and increase in cardiac index being greater in Group 1 than in Groups 2 or 3. This difference between groups was not maintained during the infusion.
在一项针对99例接受心脏手术的成年患者的多中心研究中，如果术后出现心力衰竭（肺毛细血管楔压大于8 mmHg，心脏指数小于2.5升·分钟⁻¹·米⁻²），则给予负荷剂量的米力农（50微克·千克⁻¹），随后以三种速率之一（0.375、0.5或0.75微克·千克⁻¹·分钟⁻¹）进行输注，并评估血流动力学效应。平均肺动脉压最初下降了15%（P小于0.001），这种显著下降在整个输注期间持续存在，并在停用米力农后逆转。平均肺血管阻力在整个输注期间逐渐下降，最大变化（30 - 40%）在12小时时最为明显（P小于0.05）。停用米力农输注后，这种效应的逆转不如肺毛细血管楔压或平均肺动脉压明显。来自两个中心的39例患者被回顾性地分为三组：1. 基线肺血管阻力高（大于200达因·秒·厘米⁻⁵）的二尖瓣置换术；2. 基线肺血管阻力低（100 - 200达因·秒·厘米⁻⁵）的冠状动脉血运重建术；3. 基线肺血管阻力高（大于200达因·秒·厘米⁻⁵）的冠状动脉血运重建术。所有患者的肺血管阻力均显著降低，心脏指数均升高。在15分钟时，组间存在显著差异，第1组肺血管阻力的下降和心脏指数的升高大于第2组或第3组。在输注期间，各组之间的这种差异未持续存在。
