Murday H K, Jungblut M, Limberg N J, Fischer M, Likungu J, Kirchhoff P G
Klinik und Poliklinik für Anästhesiologie und spezielle Intensivmedizin, Universität Bonn.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1993 May;28(3):161-7. doi: 10.1055/s-2007-998899.
19 patients in whom cardiopulmonary bypass (cpb) was performed during different types of cardiac operations, developed myocardial failure which remained refractory to inotropic support with increasing doses of adrenaline, dopamine and dobutamine, so that it was impossible to discontinue cpb. After changing the therapeutic approach to a new regime consisting of adrenaline, dopamine and enoximone, low-output syndrome (LCOS) could be successfully reversed in 12 of the 19 patients. In the 7 remaining patients blood pressure dropped in a clinically relevant way under treatment with enoximone. 5 of these patients needed intraaortic balloon pumping (IABP) inspite of the application of enoximone, before cpb could be successfully discontinued. In three patients receiving enoximone, persisting ventricular tachyarrhythmia appeared under treatment, and disappeared after discontinuation of the drug. One patient needed IABP and left heart bypass by means of the centrifugal pump before cpb could be duly discontinued. One patient died intraoperatively due to untreatable right ventricular failure and inability to discontinue cpb. It is concluded that enoximone represents a useful drug in a significant number of patients developing heart failure refractory to inotropic support, on emerging from cpb during cardiac surgery.
19例患者在不同类型心脏手术期间接受了体外循环（CPB），出现了心肌衰竭，随着肾上腺素、多巴胺和多巴酚丁胺剂量的增加，心肌衰竭对正性肌力支持仍无反应，因此无法停止CPB。在将治疗方法改为由肾上腺素、多巴胺和依诺昔酮组成的新方案后，19例患者中有12例的低心排综合征（LCOS）得以成功逆转。其余7例患者在接受依诺昔酮治疗时血压出现了具有临床意义的下降。其中5例患者尽管应用了依诺昔酮，但在CPB成功停止前仍需要主动脉内球囊反搏（IABP）。在3例接受依诺昔酮治疗的患者中，治疗期间出现了持续性室性心律失常，停药后消失。1例患者在CPB能够顺利停止前需要IABP和通过离心泵进行左心旁路。1例患者术中因无法治疗的右心室衰竭和无法停止CPB而死亡。结论是，对于心脏手术中CPB后出现对正性肌力支持难治的心力衰竭的大量患者，依诺昔酮是一种有用的药物。
