Kavanagh Thomas, Kilpatrick Thomas, Hardy Ben, Lee Sang, Seavill Miles, Lau Chun-Wun M, Bullard Sam, Green Samira, Cadd Matthew
Anaesthetic Department, Royal Sussex County Hospital, University Hospitals Sussex, United Kingdom.
Department of Cardiothoracic Anesthesia and the Cardiovascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.
Ann Card Anaesth. 2025 Aug 5. doi: 10.4103/aca.aca_271_24.
To summarize the evidence on the hemodynamic effects and vasopressor requirements of adult patients with known pulmonary hypertension (PH) undergoing cardiac surgery treated with intravenous and inhaled milrinone. A total of 400 patients in 5 prospective (4 RCT) studies were included for pooled analysis. There was no significant difference in the primary outcome; mean pulmonary artery pressure (MPAP) between groups (MD: -4.80, 95% CI -10.57 to 0.98). Inhaled milrinone was associated with a greater systemic vascular resistance index (SVRI) (MD: 259.21, 95% CI 168.70 to 349.72) and reduction in pulmonary capillary wedge pressure (MD: -4.64, 95% CI -5.47 to -3.81). There were no observable differences in mean arterial pressure, pulmonary vascular resistance, cardiac index, or central venous pressure. All studies included were assessed to be moderate/some concern risk of bias. Inhaled milrinone has not been shown to have a significant beneficial effect on MPAP and SVR when compared to intravenous milrinone in patients with known PH undergoing cardiac surgery. However, it has shown some benefits in maintaining MAP and improving oxygenation in this patient cohort. The study is limited by the bias of the included studies and the variability of inhaled drug dosage and administration timing, further well-powered randomized controlled trials are required.
总结已知患有肺动脉高压(PH)的成年患者在心脏手术中接受静脉注射和吸入米力农治疗时的血流动力学效应及血管升压药需求的相关证据。纳入5项前瞻性研究(4项随机对照试验)中的400例患者进行汇总分析。两组之间的主要结局;平均肺动脉压(MPAP)无显著差异(MD:-4.80,95%CI -10.57至0.98)。吸入米力农与更高的全身血管阻力指数(SVRI)(MD:259.21,95%CI 168.70至349.72)和肺毛细血管楔压降低(MD:-4.64,95%CI -5.47至-3.81)相关。平均动脉压、肺血管阻力、心脏指数或中心静脉压无明显差异。所有纳入研究的偏倚风险均被评估为中度/存在一些担忧。与静脉注射米力农相比,吸入米力农在已知患有PH的心脏手术患者中未显示出对MPAP和SVR有显著有益作用。然而,它在维持该患者队列的平均动脉压(MAP)和改善氧合方面显示出一些益处。该研究受纳入研究的偏倚以及吸入药物剂量和给药时间的变异性限制,需要进一步开展样本量充足的随机对照试验。