Badner N H, Murkin J M, Shannon N A
Department of Anaesthesia, University Hospital, University of Western Ontario, London, Canada.
J Cardiothorac Vasc Anesth. 1994 Aug;8(4):410-4. doi: 10.1016/1053-0770(94)90279-8.
This double-blind, randomized study was performed to assess the effectiveness of a single bolus dose of 2 mg/kg of amrinone given during cardiopulmonary bypass (CPB) to patients undergoing mitral valve surgery. Outcome variables were hemodynamic function and the number and amount of vasopressors or inotropes required to wean from CPB. In amrinone-treated patients, cardiac index (CI) increased significantly by 48 +/- 14% following CPB (T3) versus 10 +/- 10% for placebo-treated patients (P = 0.029). Similarly, on arrival in the intensive care unit (T4), CI was increased by 52 +/- 20% in amrinone patients versus 8 +/- 8% for placebo patients (P = 0.04). There was a corresponding decrease in systemic vascular resistance index of 47 +/- 6% at T3 in the amrinone patients versus 10 +/- 14% in placebo patients (P = 0.001), and a decrease of 30 +/- 7% at T4 versus an increase of 10 +/- 22% for the placebo patients (P = 0.036). There was no difference in other measured hemodynamic variables. While on CPB, mean arterial pressure at 5 minutes following administration of the study drug was decreased in amrinone patients by 20 +/- 4% versus 4 +/- 3% in placebo patients (P = 0.005), but was no different at 10 and 15 minutes. There were no statistically significant differences in the number of patients who required supplemental inotropes or vasopressors either during CPB, following separation from CPB, or upon arrival in the ICU. Thus, amrinone improved CI without changing pulmonary vascular resistance or the requirement for supplemental inotropes or vasopressors in patients undergoing elective mitral valve surgery.
本双盲随机研究旨在评估在二尖瓣手术患者体外循环（CPB）期间给予单剂量2mg/kg氨力农推注的有效性。观察指标为血流动力学功能以及脱离CPB所需血管升压药或正性肌力药的数量和剂量。氨力农治疗组患者在CPB后（T3）心脏指数（CI）显著增加48±14%，而安慰剂治疗组患者为10±10%（P = 0.029）。同样，在进入重症监护病房时（T4），氨力农组患者CI增加52±20%，安慰剂组患者为8±8%（P = 0.04）。氨力农组患者在T3时全身血管阻力指数相应下降47±6%，安慰剂组患者为10±14%（P = 0.001），在T4时下降30±7%，而安慰剂组患者增加10±22%（P = 0.036）。其他测量的血流动力学变量无差异。在CPB期间，氨力农组患者在给予研究药物5分钟后的平均动脉压下降20±4%，安慰剂组患者为4±3%（P = 0.005），但在10分钟和15分钟时无差异。在CPB期间、脱离CPB后或进入ICU时，需要补充正性肌力药或血管升压药的患者数量无统计学显著差异。因此，氨力农可改善择期二尖瓣手术患者的CI，而不改变肺血管阻力或补充正性肌力药或血管升压药的需求。
