Nielsen Dorthe Viemose, Algotsson Lars
aDepartment of Anesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Aarhus, Denmark bDepartment of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden.
Curr Opin Anaesthesiol. 2015 Apr;28(2):159-64. doi: 10.1097/ACO.0000000000000157.
Positive inotropic agents are widely used in the management of the critical ill patient presenting with low cardiac output state. Different inotropic agents are available, and different effects on hemodynamic endpoints may be recognized, but data on relevant clinical endpoints are scarce. A growing body of literature suggests that overuse of inotropes may have detrimental effects on cardiomyocytes, resulting in an increased risk of morbidity and mortality. The present review will summarize recent literature, focusing on outcome studies among adult patients related to use of inotropes in different clinical settings.
Use of inotropic therapy shows a manifold variation between hospitals and individual providers even after risk standardization. No recent studies have shown inotropic therapy to provide short-term and long-term improvement of morbidity and mortality in patients with advanced nonsurgical heart failure or septic shock or as part of goal-directed treatment in high-risk noncardiac surgery. Levosimendan may show beneficial effect on mortality in cardiac surgery.
A 'less is more' approach may show to be appropriate when relating to routine use of inotropes. Inotropic therapy should be restricted to patients with heart failure and clinical signs of end-organ hypoperfusion.
正性肌力药物广泛应用于治疗出现低心排血量状态的危重症患者。有多种不同的正性肌力药物可供使用，它们对血流动力学终点可能有不同的影响，但关于相关临床终点的数据却很稀少。越来越多的文献表明，过度使用正性肌力药物可能对心肌细胞产生有害影响，从而导致发病率和死亡率增加。本综述将总结近期文献，重点关注成年患者在不同临床环境中使用正性肌力药物的结局研究。
即使在进行风险标准化之后，不同医院和个体医疗服务提供者之间使用正性肌力药物治疗的情况仍存在很大差异。近期没有研究表明，对于晚期非手术性心力衰竭或感染性休克患者，或者作为高危非心脏手术目标导向治疗的一部分，使用正性肌力药物治疗能在短期和长期内改善发病率和死亡率。左西孟旦可能对心脏手术患者的死亡率有有益影响。
在常规使用正性肌力药物方面，“少即是多”的方法可能是合适的。正性肌力药物治疗应仅限于患有心力衰竭且有终末器官灌注不足临床体征的患者。
