Deeb G M, Bolling S F
Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor 48109.
J Cardiothorac Anesth. 1989 Dec;3(6 Suppl 2):33-7. doi: 10.1016/0888-6296(89)90057-4.
Orthotopic heart transplantation is contraindicated in patients with pulmonary hypertension and an elevated pulmonary vascular resistance. In an attempt to make otherwise unacceptable patients possible candidates for heart transplantation, amrinone was administered intravenously to 27 individuals with a transpulmonary gradient and pulmonary vascular resistance in the abnormal range. Twenty-four of 27 patients (89%) responded positively. Twenty-one of 27 (78%) went on to transplantation and 20 of 21 (95%) survived the procedure. A second study compared amrinone therapy with conventional therapy in 38 potential transplant candidates with pulmonary hypertension. Amrinone was more effective in reducing pulmonary hypertension than conventional therapy with high-dose diuretics, digitalis, and captopril (86% v 63%). Survival rate of those awaiting transplantation was also significantly higher in the amrinone group (91% v 63%). Although the protocol for comparing the two regimens does not allow for extrapolation of the results (amrinone was administered in-hospital under close monitoring, whereas conventional therapy was self-administered at home), the findings confirm the clinical impression that amrinone seems more effective and safer than conventional therapy in the treatment of potential heart transplant patients with pulmonary hypertension.
肺动脉高压和肺血管阻力升高的患者禁忌进行原位心脏移植。为了使原本不适合的患者有可能成为心脏移植的候选者，对27名经肺梯度和肺血管阻力处于异常范围的个体静脉注射了氨力农。27名患者中有24名（89%）反应良好。27名患者中有21名（78%）继续接受移植，21名患者中有20名（95%）手术成功存活。第二项研究在38名潜在的有肺动脉高压的移植候选者中比较了氨力农治疗与传统治疗。氨力农在降低肺动脉高压方面比使用大剂量利尿剂、洋地黄和卡托普利的传统治疗更有效（86%对63%）。氨力农组等待移植者的存活率也显著更高（91%对63%）。尽管比较两种治疗方案的研究方案不允许对结果进行推断（氨力农是在医院密切监测下给药，而传统治疗是患者在家自行给药），但研究结果证实了临床印象，即氨力农在治疗潜在的有肺动脉高压的心脏移植患者方面似乎比传统治疗更有效、更安全。
