Nomura K, Kurosawa H, Hashimoto K, Yamagishi M, Koyanagi K, Tanaka K, Mashiko K, Nakano M
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Oct;42(10):1865-70.
The effects of Amrinone on cardiac function soon after extracorporeal circulation (ECC) were studied in 5 patients including mitral valvuloplasty, VSD closure, Fontan operation and coronary AV fistel closure. In all patients, left ventricular volume load decreased postoperatively. To evaluate the efficacy, we obtained left ventricular pressure-volume loops (P-V loop) before and after ECC and after intravenous administration of Amrinone (1 mg/kg) following ECC. P-V loops were produced by measuring left ventricular pressure using a Miller catheter which was retrogradely advanced from the ascending aorta into the left ventricle and by measuring left ventricular diameter to calculate left ventricular volume with Teichholtz' formula. Although no apparent difference of Emax was recognized before and after ECC, Emax increased from 3.2 +/- 2.5 mmHg/cm3 to 5.9 +/- 4.7 mmHg/cm3 after the administration of Amrinone. The left ventricular "systolic" pressure-volume area (PVA) which is the sum of stroke work (SW) and elastic potential energy decreased from 34.4 +/- 16.4 gm to 30.9 +/- 17.8 gm after Amrinone. No difference was also recognized in left ventricular end-diastolic pressure. Ejection fraction increased from 50 +/- 17.5% to 56.1 +/- 17.3%. These results suggested that Amrinone could improve the left ventricular function without prominent change in myocardial oxygen consumption immediately after open heart surgery.
我们对5例接受体外循环（ECC）后不久的患者进行了氨力农对心脏功能影响的研究，这些患者包括二尖瓣成形术、室间隔缺损修补术、Fontan手术和冠状动静脉瘘闭合术。所有患者术后左心室容量负荷均降低。为评估疗效，我们在ECC前、ECC后以及ECC后静脉注射氨力农（1 mg/kg）后获取了左心室压力-容积环（P-V环）。P-V环通过使用从升主动脉逆行推进至左心室的米勒导管测量左心室压力，并通过测量左心室直径利用Teichholtz公式计算左心室容积来生成。尽管ECC前后未发现Emax有明显差异，但注射氨力农后Emax从3.2±2.5 mmHg/cm³增加至5.9±4.7 mmHg/cm³。左心室“收缩期”压力-容积面积（PVA），即搏功（SW）与弹性势能之和，在使用氨力农后从34.4±16.4 gm降至30.9±17.8 gm。左心室舒张末期压力也未发现差异。射血分数从50±17.5%增加至56.1±17.3%。这些结果表明，氨力农可在心脏直视手术后立即改善左心室功能，而心肌氧耗无显著变化。
