Maeda Takuma, Toda Koichi, Kamei Masataka, Miyata Shigeki, Ohnishi Yoshihiko
Department of Anesthesiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565 Japan ; Division of Transfusion Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565 Japan.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871 Japan.
Springerplus. 2015 Dec 30;4:821. doi: 10.1186/s40064-015-1649-4. eCollection 2015.
The purpose of this study was to elucidate the difference in inotrope use between patients who underwent left ventricular assist device (LVAD) implantation with preoperative extracorporeal membrane oxygenation (ECMO) and those who underwent LVAD implantation without preoperative ECMO. One hundred and eight patients who underwent LVAD implantation were enrolled in this study. Prior to LVAD implantation, 27 patients received ECMO support (ECMO group) and the other 81 patients did not (non-ECMO group). Cardiac index (CI), mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), and the vasoactive inotropic score (VIS) were recorded at weaning from cardiopulmonary bypass (CPB), 30 min after weaning from CPB (min after CPB), 60 min after CPB, and at the end of surgery. MAP and VIS were also recorded before induction of anesthesia (baseline). The modified VIS was defined as: (dopamine µg/kg/min × 1 + dobutamine µg/kg/min × 1 + epinephrine µg/kg/min × 100 + noradrenaline µg/kg/min × 100 + milrinone µg/kg/min × 10 + olprinone µg/kg/min × 25). There were no significant differences between the ECMO group and the non-ECMO group in terms of hemodynamic parameters such as MAP, CI, and SvO2. However, the ECMO group had higher VIS and noradrenaline doses than that of non-ECMO group (p = 0.030 and p = 0.044, respectively). VIS was significantly higher in ECMO group at 30 min after CPB (p = 0.03), 60 min after CPB (p = 0.003), and at the end of the surgery (p < 0.001). The doses of noradrenaline were significantly higher in ECMO group at 60 min after CPB (p = 0.013), and at the end of surgery (p = 0.002). Patients who received ECMO support prior to LVAD implantation required significantly more noradrenaline to maintain normal levels of hemodynamic parameters compared with patients without ECMO.
本研究的目的是阐明术前接受体外膜肺氧合（ECMO）的左心室辅助装置（LVAD）植入患者与未接受术前ECMO的LVAD植入患者在使用血管活性药物方面的差异。本研究纳入了108例行LVAD植入术的患者。在LVAD植入术前，27例患者接受了ECMO支持（ECMO组），另外81例患者未接受（非ECMO组）。在体外循环（CPB）撤机时、CPB撤机后30分钟、CPB撤机后60分钟以及手术结束时记录心脏指数（CI）、平均动脉压（MAP）、混合静脉血氧饱和度（SvO2）和血管活性药物评分（VIS）。在麻醉诱导前（基线）也记录MAP和VIS。改良的VIS定义为：（多巴胺μg/kg/min×1 + 多巴酚丁胺μg/kg/min×1 + 肾上腺素μg/kg/min×100 + 去甲肾上腺素μg/kg/min×100 + 米力农μg/kg/min×10 + 奥普力农μg/kg/min×25）。在MAP、CI和SvO2等血流动力学参数方面，ECMO组和非ECMO组之间无显著差异。然而，ECMO组的VIS和去甲肾上腺素剂量高于非ECMO组（分别为p = 0.030和p = 0.044）。在CPB后30分钟（p = 0.03）、CPB后60分钟（p = 0.003）以及手术结束时（p < 0.001），ECMO组的VIS显著更高。在CPB后60分钟（p = 0.013）以及手术结束时（p = 0.002），ECMO组的去甲肾上腺素剂量显著更高。与未接受ECMO的患者相比，在LVAD植入术前接受ECMO支持的患者需要显著更多的去甲肾上腺素来维持血流动力学参数的正常水平。
