Hendon Emily, Kane Jennifer, Golem Gina M, McBroom Amanda, Flores Saul, Wong Joshua, Villarreal Enrique G, Loomba Rohit S
Pediatric Cardiology, Advocate Children's Hospital, Chicago, IL, USA.
Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA.
Ann Pediatr Cardiol. 2022 Jan-Feb;15(1):34-40. doi: 10.4103/apc.apc_39_21. Epub 2022 Jun 14.
Vasoactive medications are frequently used in the preoperative stage to balance the pulmonary and systemic blood flow. However, not much is known about the effects of these agents during this stage.
The primary objective of this study was to characterize the acute effects of vasoactive medications in children with parallel circulation before either the hybrid or Norwood procedure.
This is a single-center, cross-sectional, retrospective study.
Hemodynamic and systemic oxygen delivery data were captured from patients' vital signs, arterial blood gases, near-infrared spectroscopy monitoring (NIRS). Data for each patient were collected before the initiation of a vasoactive medication and again 6 h after.
Data were analyzed using paired -tests, and analysis of covariance.
A total of 139 patients were identified. After data extraction the following patients were included before the initial intervention: 7 were on milrinone, 22 were on dopamine, and 17 were on dobutamine. Dopamine and dobutamine were found to significantly increase systolic blood pressure. Only dopamine increased pH (mean difference 0.04), decreased paCO2 (mean difference -7.1), decreased lactate (mean difference -0.6 mmol/L), and decreased in bedside Qp: Qs (mean difference -7.5) after continuous infusion for 6 h. Milrinone was not associated with any significant hemodynamic change.
In this study, dopamine was independently associated with improvement in markers of systemic oxygen delivery 6 h after initiation. Dobutamine and dopamine were associated with increased in blood pressure. Well-powered studies are required to detect changes in lactate and NIRS.
血管活性药物常用于术前阶段，以平衡肺循环和体循环血流。然而，对于这些药物在此阶段的作用了解不多。
本研究的主要目的是描述血管活性药物对并行循环儿童在杂交手术或诺伍德手术前的急性影响。
这是一项单中心、横断面、回顾性研究。
从患者的生命体征、动脉血气、近红外光谱监测（NIRS）中获取血流动力学和全身氧输送数据。在开始使用血管活性药物前及用药6小时后收集每位患者的数据。
使用配对t检验和协方差分析对数据进行分析。
共确定了139例患者。在初始干预前纳入了以下患者：7例使用米力农，22例使用多巴胺，17例使用多巴酚丁胺。发现多巴胺和多巴酚丁胺能显著提高收缩压。持续输注6小时后，只有多巴胺能提高pH值（平均差异0.04）、降低动脉血二氧化碳分压（平均差异-7.1）、降低乳酸水平（平均差异-0.6 mmol/L）并降低床旁肺循环血流量与体循环血流量比值（Qp:Qs）（平均差异-7.5）。米力农与任何显著的血流动力学变化均无关联。
在本研究中，多巴胺在开始使用6小时后与全身氧输送指标的改善独立相关。多巴酚丁胺和多巴胺与血压升高有关。需要开展样本量充足的研究来检测乳酸和NIRS的变化。
