James Adam T, Corcoran John D, McNamara Patrick J, Franklin Orla, El-Khuffash Afif F
1Department of Paediatrics,The Rotunda Hospital,Dublin,Ireland.
3Department of Physiology and Experimental Medicine,Hospital for Sick Children,Toronto,Canada.
Cardiol Young. 2016 Jan;26(1):90-9. doi: 10.1017/S1047951114002698. Epub 2015 Jan 20.
Milrinone may be an appropriate adjuvant therapy for infants with persistent pulmonary hypertension of the newborn. We aimed to describe the effect of milrinone administration on right and left ventricular function in infants with persistent pulmonary hypertension not responding to inhaled nitric oxide after 4 hours of administration.
This is a retrospective review of infants born after or at 34 weeks of gestation with persistent pulmonary hypertension who received milrinone treatment. The primary endpoint was the effect of milrinone on myocardial performance and haemodynamics, including right and left ventricular outputs, tissue Doppler velocities, right ventricle and septal strain, and strain rate. Secondary endpoints examined included duration of inhaled nitric oxide and oxygen support.
A total of 17 infants with a mean (standard deviation) gestation and birth weight of 39.8 (2.0) weeks and 3.45 (0.39) kilograms, respectively, were included in the study. The first echocardiogram was performed 15 hours after the commencement of nitric oxide inhalation. Milrinone treatment was started at a median time of 1 hour after the echocardiogram and was associated with an increase in left ventricular output (p=0.04), right ventricular output (p=0.004), right ventricle strain (p=0.01) and strain rate (p=0.002), and left ventricle s (p<0.001) and a (p=0.02) waves. There was a reduction in nitric oxide dose and oxygen requirement over the subsequent 72 hours (all p<0.05).
The use of milrinone as an adjunct to nitric oxide is worth further exploration, with preliminary evidence suggesting an improvement in both oxygenation and myocardial performance in this group of infants.
米力农可能是治疗新生儿持续性肺动脉高压的合适辅助疗法。我们旨在描述在给予吸入一氧化氮4小时后仍无反应的持续性肺动脉高压婴儿中，使用米力农对左右心室功能的影响。
这是一项对孕周34周及以后出生且患有持续性肺动脉高压并接受米力农治疗的婴儿的回顾性研究。主要终点是米力农对心肌功能和血流动力学的影响，包括左右心室输出量、组织多普勒速度、右心室和室间隔应变以及应变率。检查的次要终点包括吸入一氧化氮的持续时间和氧支持情况。
共有17名婴儿纳入研究，其平均（标准差）孕周和出生体重分别为39.8（2.0）周和3.45（0.39）千克。首次超声心动图检查在开始吸入一氧化氮15小时后进行。米力农治疗在超声心动图检查后中位数1小时开始，与左心室输出量增加（p = 0.04）、右心室输出量增加（p = 0.004）、右心室应变增加（p = 0.01）和应变率增加（p = 0.002）以及左心室s波（p < 0.001）和a波（p = 0.02）有关。在随后的72小时内，一氧化氮剂量和氧需求均降低（所有p < 0.05）。
米力农作为一氧化氮的辅助药物的应用值得进一步探索，初步证据表明该组婴儿的氧合和心肌功能均有改善。
