From the Department of Intensive Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Department of Intensive Care Medicine, Western Health, Melbourne, Victoria, Australia.
Anesth Analg. 2020 Aug;131(2):527-536. doi: 10.1213/ANE.0000000000004793.
Catecholamine inotropes are frequently used after cardiopulmonary bypass (CPB) but may have undesirable effects. The aim was to identify whether the routine use of inhaled pulmonary vasodilators might reduce the requirement for inotrope drugs after cardiac surgery.
Retrospective cohort study of sequential patients undergoing cardiac surgery at the Royal Melbourne Hospital performed by a single surgeon and anesthesia care team, within 14 months before and after routine implementation of inhaled pulmonary vasodilators, August 2017. Milrinone 4 mg and iloprost 20 µg were inhaled using a vibrating mesh nebulizer (Aerogen) before initiation of CPB and at chest closure. Other aspects of clinical management were unaltered over the time period. Two investigators blinded to each other extracted data from electronic and written medical records. The primary outcome was any use of inotropes in the perioperative period; a Fisher exact test was used to analyze any differences between the 2 groups. Demographic data, hemodynamic data, and use of inotropes and vasopressors were collected from induction of anesthesia to 36 hours postoperative in the intensive care unit (ICU). Hospital and ICU length of stay, cost, and complications were collected.
Any use of inotropes was significantly lower with inhaled pulmonary dilators (62.5% vs 86.8%, odds ratio [95% confidence interval {CI}], 0.253 (0.083-0.764); P = .011), including intraoperative inotrope use (37.5% vs 86.8%, odds ratio [95% CI], 0.091 (0.03-0.275); P < .001). ICU length of stay was significantly lower with inhaled pulmonary dilators (45 hours, interquartile range [IQR], 27-65 vs 50 hours, IQR, 45-74; P = .026). There were no significant differences among major postoperative complications or costs between groups.
Routine use of inhaled milrinone 4 mg and iloprost 20 µg before and after CPB is associated with reduced postoperative inotrope use.
心肺转流（CPB）后常使用儿茶酚胺正性肌力药物，但可能会产生不良影响。本研究旨在确定常规使用吸入性肺血管扩张剂是否可以减少心脏手术后对正性肌力药物的需求。
这是一项回顾性队列研究，纳入了在单名外科医生和麻醉护理团队于 2017 年 8 月在皇家墨尔本医院进行心脏手术后的连续患者，该研究在常规使用吸入性肺血管扩张剂前后 14 个月内进行。在开始 CPB 之前和关胸前，使用振动网孔雾化器（Aerogen）吸入米力农 4mg 和伊洛前列素 20μg。在此期间，临床管理的其他方面保持不变。两名研究人员彼此之间均不知道对方的信息，从电子病历和书面病历中提取数据。主要结局为围手术期使用任何正性肌力药物；使用 Fisher 确切检验分析两组之间的任何差异。从麻醉诱导到 ICU 术后 36 小时收集人口统计学数据、血流动力学数据以及正性肌力药物和血管加压药的使用情况。收集住院和 ICU 住院时间、费用以及并发症数据。
使用吸入性肺扩张剂的患者使用任何正性肌力药物的比例显著降低（62.5% vs 86.8%，比值比[95%置信区间]，0.253（0.083-0.764）；P =.011），包括术中使用正性肌力药物（37.5% vs 86.8%，比值比[95%置信区间]，0.091（0.03-0.275）；P <.001）。使用吸入性肺扩张剂的患者 ICU 住院时间显著缩短（45 小时，四分位距[IQR]，27-65 与 50 小时，IQR，45-74；P =.026）。两组之间主要术后并发症或费用无显著差异。
CPB 前后常规使用 4mg 米力农和 20μg 伊洛前列素与术后减少使用正性肌力药物有关。
