Department of Paediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland.
Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.
Pediatr Crit Care Med. 2018 Jul;19(7):619-625. doi: 10.1097/PCC.0000000000001533.
Dobutamine and milrinone are commonly used after open-heart surgery to prevent or treat low cardiac output syndrome. We sought to compare efficacy and safety of these drugs in pediatric patients.
Prospective, single-center, double-blinded, randomized clinical pilot study.
Tertiary-care university children's hospital postoperative pediatric cardiac ICU.
After written consent, 50 consecutive patients (age, 0.2-14.2 yr; median, 1.2 yr) undergoing open-heart surgery for congenital malformations were included.
After cardiopulmonary bypass, a continuous infusion of either dobutamine or milrinone was administered for the first 36 postoperative hours. Maximum dose: dobutamine 6 µg/kg/min, milrinone 0.75 µg/kg/min.
There were no significant differences in demographic data, complexity of surgery, and intraoperative characteristics between the two study groups (dobutamine vs milrinone). Efficacy was defined as need for additional vasoactive support, which did not differ between groups (dobutamine 61% vs milrinone 67%; p = 0.71). Sodium nitroprusside was used more often in the dobutamine group (42% vs 13%; p = 0.019). Systolic blood pressure showed a trend toward higher values in the dobutamine group, whereas both drugs increased heart rate early postoperatively. Echocardiography demonstrated a consistently good cardiac function in both groups. Central venous oxygen saturation, serum lactate levels, urine output, time to chest tube removal, length of mechanical ventilation, ICU, and hospital stay were similar in both groups. Both drugs were well tolerated, no serious adverse events occurred.
Dobutamine and milrinone are safe, well tolerated, and equally effective in prevention of low cardiac output syndrome after pediatric cardiac surgery. The hemodynamic response of the two drugs is comparable. In uncomplicated cases, a trend toward the more cost-saving dobutamine might be anticipated; however, milrinone demonstrated a trend toward higher efficacy in afterload reduction.
在心脏直视手术后，多巴酚丁胺和米力农常用于预防或治疗低心输出综合征。我们旨在比较这两种药物在儿科患者中的疗效和安全性。
前瞻性、单中心、双盲、随机临床试点研究。
三级保健大学儿童医院心脏术后儿科 ICU。
在书面同意后，连续纳入 50 例（年龄 0.2-14.2 岁；中位数 1.2 岁）接受先天性畸形心脏直视手术的患者。
体外循环后，在术后的头 36 小时内，连续输注多巴酚丁胺或米力农。最大剂量：多巴酚丁胺 6 µg/kg/min，米力农 0.75 µg/kg/min。
两组患者的人口统计学数据、手术复杂性和术中特征均无显著差异（多巴酚丁胺组与米力农组）。疗效定义为需要额外的血管活性支持，两组之间无差异（多巴酚丁胺组 61%，米力农组 67%；p = 0.71）。米力农组更多地使用硝普钠（42%比 13%；p = 0.019）。多巴酚丁胺组的收缩压呈升高趋势，而两种药物均在术后早期增加心率。超声心动图显示两组心脏功能均良好。两组中心静脉血氧饱和度、血清乳酸水平、尿量、胸腔引流管拔除时间、机械通气时间、ICU 和住院时间均相似。两种药物均耐受良好，无严重不良事件发生。
多巴酚丁胺和米力农在预防儿科心脏手术后低心输出综合征方面是安全的，耐受性好，且疗效相当。两种药物的血流动力学反应相当。在不复杂的情况下，预计更节省成本的多巴酚丁胺可能会有趋势，但米力农在降低后负荷方面显示出趋势更高的疗效。
