Royster R L, Butterworth J F, Prielipp R C, Zaloga G P, Lawless S G, Spray B J, Kon N D, Wallenhaupt S L, Cordell A R
Department of Anesthesia, Bowman Gray School of Medicine, Wake Forest University Medical Center, Winston-Salem, NC 27157-1009.
Anesth Analg. 1993 Oct;77(4):662-72. doi: 10.1213/00000539-199310000-00003.
Amrinone, a phosphodiesterase inhibitor, and epinephrine, an alpha- and beta-adrenergic receptor agonist, are inotropic drugs used during cardiac surgery to reverse myocardial depression after cardiopulmonary bypass. However, these drugs have not been compared separately, or in combination, in this patient population. We hypothesized that the combination might have complementary actions in improving myocardial function. We, therefore, compared amrinone, epinephrine, and the combination of amrinone and epinephrine in a randomized, blinded, placebo-controlled study in patients undergoing coronary artery bypass grafting. Forty patients with ejection fractions > 0.45 were studied. Right ventricular ejection fraction pulmonary artery catheters and radial arterial catheters were inserted before fentanyl-midazolam anesthesia. After separation from bypass, patients received either a placebo (n = 20) or amrinone bolus (1.5 mg/kg, n = 20) at time 0 and a placebo (n = 20) or epinephrine (30 ng.kg-1.min-1, n = 20) infusion at time 5 min. This resulted in four study groups, n = 10 in each group. Data were collected every 2.5 min for 10 min. Epinephrine, amrinone, and the combination of both drugs significantly increased cardiac output, stroke volume, O2 delivery, and left ventricular stroke work. The increase in stroke volume (P < 0.05) was 12 +/- 6, 16 +/- 4, and 30 +/- 4 mL/beat with epinephrine, amrinone, and the combination of amrinone and epinephrine, respectively. The amrinone-epinephrine combination increased stroke volume as much as the sum of amrinone and epinephrine given separately. Systemic vascular resistance and pulmonary vascular resistance decreased with amrinone and amrinone-epinephrine, but not with epinephrine. Epinephrine increased mean arterial and mean pulmonary arterial pressures. Right ventricular ejection fraction did not significantly increase (P = 0.09) with epinephrine, but increased significantly with amrinone (0.45 to 0.53, P = 0.01), and with the combination (0.43 to 0.55, P = 0.006). These data indicate that amrinone and epinephrine effectively increase myocardial performance during cardiac surgery. Right ventricular function especially was improved with amrinone and the combination of amrinone and epinephrine. The combined effects of amrinone and epinephrine may be useful in patients recovering from the ischemia and reperfusion injury resulting from coronary artery bypass grafting.
氨力农是一种磷酸二酯酶抑制剂，肾上腺素是一种α和β肾上腺素能受体激动剂，它们都是心脏手术中用于逆转体外循环后心肌抑制的正性肌力药物。然而，在这类患者群体中，尚未对这些药物进行单独比较或联合比较。我们推测联合使用可能在改善心肌功能方面具有互补作用。因此，我们在一项针对接受冠状动脉搭桥术患者的随机、双盲、安慰剂对照研究中，比较了氨力农、肾上腺素以及氨力农与肾上腺素的联合使用情况。研究了40名射血分数>0.45的患者。在芬太尼-咪达唑仑麻醉前插入右心室射血分数肺动脉导管和桡动脉导管。脱离体外循环后，患者在0时刻接受安慰剂（n = 20）或氨力农推注（1.5 mg/kg，n = 20），并在5分钟时接受安慰剂（n = 20）或肾上腺素输注（30 ng·kg-1·min-1，n = 20）。这产生了四个研究组，每组n = 10。每2.5分钟收集一次数据，共收集10分钟。肾上腺素、氨力农以及两种药物的联合使用均显著增加了心输出量、每搏输出量、氧输送和左心室每搏功。使用肾上腺素、氨力农以及氨力农与肾上腺素联合使用时，每搏输出量的增加（P < 0.05）分别为12±6、16±4和30±4 mL/次心跳。氨力农与肾上腺素联合使用时每搏输出量的增加幅度与单独使用氨力农和肾上腺素的增加幅度之和相同。使用氨力农和氨力农与肾上腺素联合使用时，全身血管阻力和肺血管阻力降低，但使用肾上腺素时未降低。肾上腺素增加了平均动脉压和平均肺动脉压。使用肾上腺素时右心室射血分数未显著增加（P = 0.09），但使用氨力农时显著增加（从0.45增加到0.53，P = 0.01），使用联合用药时也显著增加（从0.43增加到0.55，P = 0.006）。这些数据表明，氨力农和肾上腺素在心脏手术期间可有效提高心肌性能。氨力农以及氨力农与肾上腺素联合使用尤其改善了右心室功能。氨力农和肾上腺素的联合作用可能对从冠状动脉搭桥术引起的缺血和再灌注损伤中恢复的患者有用。
