Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India.
J Cardiothorac Vasc Anesth. 2010 Oct;24(5):797-801. doi: 10.1053/j.jvca.2009.10.024. Epub 2010 Jan 6.
The aim of the present study was to compare the acute effects of inhaled milrinone and inhaled nitroglycerin on pulmonary and systemic hemodynamics in children with acyanotic congenital heart disease (left-to-right shunt) and pulmonary artery hypertension.
Randomized clinical trial.
Catheterization laboratory of a tertiary care hospital.
Thirty-five children below the age of 12 years who were suffering from acyanotic congenital heart disease with left-to-right intracardiac shunt and pulmonary artery hypertension (mean PA pressure > 30 mmHg).
Right-heart catheterization was done using an end-hole balloon wedge pressure catheter. Baseline pulmonary and systemic hemodynamic parameters were recorded for all patients while breathing room air. All patients then underwent pulmonary vasodilator testing with 100% oxygen. Following this, patients were randomized into two groups and received either inhaled milrinone (group M, n = 18) or inhaled nitroglycerin (group N, n = 17) in a 50% air-oxygen mixture. Oximetry data were used to calculate systemic and pulmonary cardiac output based on Fick's principle.
Systolic, diastolic, and mean pulmonary artery pressures decreased significantly in both the groups after drug nebulization, while there were no significant changes in systemic pressures. The percentage decrease from baseline in systolic (5.2% v 8.6%, p = 0.43), diastolic (19.5% v 16.8%, p = 0.19) and mean (14.9% v14.5%, p = 0.29) pulmonary artery pressures were comparable in both groups. The pulmonary vascular resistance index (PVRI) decreased from 9.0 ± 3.9 to 2.9 ± 1.7 Wood Units (WU)/m(2) in group M (p < 0.001) and from 8.6 ± 3.8 to 3.2 ± 3.3 WU/m(2) in group N (p < 0.001). The fall in pulmonary artery pressures after drug nebulization in both groups was comparable to the fall seen with 100% oxygen.
Both milrinone and nitroglycerin when given via the inhaled route significantly decrease systolic, diastolic and mean pulmonary artery pressures as well as PVRI without significant effects on systemic hemodynamics. Both the drugs given via inhaled route therefore can offer a good therapeutic choice and can help decrease the high inspired oxygen concentrations needed to treat pulmonary artery hypertensive episodes in perioperative settings.
本研究旨在比较吸入米力农和吸入硝酸甘油对伴有肺动脉高压的非发绀型先天性心脏病（左向右分流）患儿肺和全身血液动力学的急性影响。
随机临床试验。
三级医院导管室。
35 名年龄在 12 岁以下的患有非发绀型先天性心脏病、左向右心内分流和肺动脉高压（平均肺动脉压>30mmHg）的儿童。
使用端孔球囊楔压导管进行右心导管检查。所有患者均在呼吸室内空气时记录基础肺和全身血液动力学参数。所有患者随后接受 100%氧气进行肺血管扩张剂测试。在此之后，患者被随机分为两组，并分别接受吸入米力农（组 M，n=18）或吸入硝酸甘油（组 N，n=17）的 50%空气-氧气混合物。根据 Fick 原理，使用血氧饱和度数据计算全身和肺心输出量。
两组患者在药物雾化后，收缩压、舒张压和平均肺动脉压均显著下降，而全身压力无明显变化。与基线相比，收缩压（5.2%比 8.6%，p=0.43）、舒张压（19.5%比 16.8%，p=0.19）和平均（14.9%比 14.5%，p=0.29）肺动脉压的下降百分比在两组之间无差异。肺血管阻力指数（PVRI）从 9.0±3.9 降至 2.9±1.7 Wood 单位（WU）/m2（p<0.001），从 8.6±3.8 降至 3.2±3.3 WU/m2（p<0.001）。两组患者药物雾化后肺动脉压下降与 100%氧气下降相当。
吸入米力农和硝酸甘油均可显著降低收缩压、舒张压和平均肺动脉压以及 PVRI，而对全身血液动力学无明显影响。两种药物通过吸入途径给药都可以作为一种很好的治疗选择，并有助于减少围手术期治疗肺动脉高压发作所需的高吸入氧浓度。
