Palmaers Thomas, Albrecht Sven, Heuser Fabian, Leuthold Christian, Schuettler Juergen, Schmitz Bernd
Department of Anesthesiology, University Hospital Erlangen, Germany.
Anesthesiology. 2007 Jan;106(1):100-6. doi: 10.1097/00000542-200701000-00018.
Milrinone used for acute cardiac insufficiency could be of interest during cardiopulmonary resuscitation because of its positive inotropic effects. In this study, the combination of milrinone-vasopressin was compared with epinephrine and vasopressin, as well as with the combination of epinephrine-vasopressin, in reference to hemodynamics.
Thirty-two pigs underwent ligation of the circumflex coronary artery and induction of ventricular fibrillation lasting for 4 min. Cardiopulmonary resuscitation was performed after randomization to one of four groups: epinephrine (30-microg/kg bolus), vasopressin (0.4-U/kg bolus), epinephrine-vasopressin (15-microg/kg epinephrine bolus, 0.2-U/kg vasopressin bolus), or milrinone-vasopressin (0.4-U/kg vasopressin bolus, 50-microg/kg milrinone bolus over 5 min and a continuous infusion of 0.4 microg.kg.min). The hemodynamic variables were measured before cardiopulmonary resuscitation as well as 4, 8, 15, and 30 min after return of spontaneous circulation.
All animals were resuscitated successfully. The animals of the milrinone-vasopressin group displayed significantly (P<0.05) higher cardiac index values (30 min after return of spontaneous circulation: epinephrine, 65.8+/-13.2; vasopressin, 70.7+/-18.3; epinephrine-vasopressin, 69.1+/-36.2; milrinone-vasopressin, 120.7+/-34.8 ml.min.kg) without a decrease in mean arterial pressure or coronary perfusion pressure.
The combination of vasopressin-milrinone as compared with epinephrine during cardiopulmonary resuscitation leads to an improved cardiac index without relevant decrease of mean arterial pressure or coronary perfusion pressure.
米力农因其正性肌力作用，在用于急性心功能不全时，可能对心肺复苏有益。在本研究中，就血流动力学方面，将米力农 - 血管加压素联合用药与肾上腺素和血管加压素联合用药以及肾上腺素 - 血管加压素联合用药进行了比较。
32头猪接受了左旋冠状动脉结扎并诱发室颤持续4分钟。随机分为四组后进行心肺复苏：肾上腺素组（30μg/kg静脉推注）、血管加压素组（0.4U/kg静脉推注）、肾上腺素 - 血管加压素组（15μg/kg肾上腺素静脉推注，0.2U/kg血管加压素静脉推注）或米力农 - 血管加压素组（0.4U/kg血管加压素静脉推注，50μg/kg米力农在5分钟内静脉推注并持续输注0.4μg·kg·min）。在心肺复苏前以及自主循环恢复后4分钟（min）、8分钟、15分钟和30分钟测量血流动力学变量。
所有动物均成功复苏。米力农 - 血管加压素组动物在自主循环恢复30分钟时的心脏指数值显著更高（P<0.05）（自主循环恢复30分钟时：肾上腺素组，65.8±13.2；血管加压素组，70.7±18.3；肾上腺素 - 血管加压素组，69.1±36.2；米力农 - 血管加压素组，120.7±34.8 ml·min·kg），且平均动脉压或冠状动脉灌注压未降低。
与肾上腺素相比，在心肺复苏期间血管加压素 - 米力农联合用药可改善心脏指数，而平均动脉压或冠状动脉灌注压无明显降低。
