O-Yurvati A H, Laub G W, Sanders S P, Dullye L J, Reibman J B, McGrath L B
Department of Thoracic and Cardiovascular Surgery, Deborah Heart and Lung Center Browns Mills, NJ, USA.
Int Surg. 1995 Jul-Sep;80(3):231-4.
Pulmonary microvascular pressures (PMVP) have important diagnostic and therapeutic implications when utilized to monitor pulmonary dysfunction after cardiopulmonary bypass. Elevations in PMVP may lead to interstitial pulmonary edema and right ventricular failure. This study evaluated the influence of Dobutamine on PMVP in a trial of 80 consecutive patients undergoing isolated coronary artery bypass grafting (CABG). Forty patients were randomized to the Dobutamine study group and received 5 micrograms/kg/min of Dobutamine for 24 hours, starting at the completion of bypass. In the control group, patients received postoperative inotropic support as indicated (dopamine [n = 10] or amrinone [n = 6]) by the clinical situation. PMVP values were computed based on continuous hemodynamic monitoring at 6, 12, 18 and 24 hours. Preoperative demographic descriptors and operative variables were comparable between the two groups. Postoperative fluid requirements and nonpulmonary complications were also similar between groups. Upon completion of cardiopulmonary bypass, PMVP (mean +/- SD) were PMVP decreased over time in the Dobutamine group, while it did not change in the control group. Clinically mean time to extubation was reduced from 18 to 12 hours (p < 0.06) in the Dobutamine group. We conclude that in patients undergoing cardiopulmonary bypass, the postoperative administration of Dobutamine significantly reduces the PMVP. This may reduce pulmonary interstitial edema and pulmonary complications. Upon completion of cardiopulmonary bypass, PMVP (mean +/- SD) were measured at 6 hours, 12 hours, 18 hours and 24 hours. The control group measured 25 +/- 5 mmHg, 26 +/- 2 mmHg, 27 +/- 3 mmHg and 28 +/- 3 mmHg. The Dobutamine group measured 25 +/- 6 mmHg, 24 +/- 3 mmHg, 22 +/- 2 mmHg and 18 +/- 5 mmHg. PMVP decreased over time in the Dobutamine group (p < 0.001), while it did not change in the control group. Clinically mean time to extubation was reduced from 18 to 12 hours (p < 0.06) in the Dobutamine group. We conclude that in patients undergoing cardiopulmonary bypass, the post-operative administration of Dobutamine significantly reduced PMVP. This may reduce pulmonary interstitial edema and pulmonary complications post cardiopulmonary bypass.
在用于监测体外循环后肺功能障碍时，肺微血管压力（PMVP）具有重要的诊断和治疗意义。PMVP升高可能导致间质性肺水肿和右心室衰竭。本研究在一项对80例连续接受单纯冠状动脉旁路移植术（CABG）的患者的试验中，评估了多巴酚丁胺对PMVP的影响。40例患者被随机分配到多巴酚丁胺研究组，从体外循环结束时开始，接受5微克/千克/分钟的多巴酚丁胺治疗24小时。在对照组中，患者根据临床情况接受术后所需的正性肌力支持（多巴胺[n = 10]或氨力农[n = 6]）。基于在6、12、18和24小时进行的连续血流动力学监测计算PMVP值。两组之间术前人口统计学描述和手术变量具有可比性。两组术后液体需求量和非肺部并发症也相似。体外循环结束时，多巴酚丁胺组的PMVP（均值±标准差）随时间下降，而对照组则没有变化。多巴酚丁胺组临床拔管平均时间从18小时缩短至12小时（p < 0.06）。我们得出结论，在接受体外循环的患者中，术后给予多巴酚丁胺可显著降低PMVP。这可能减少肺间质水肿和肺部并发症。体外循环结束时，在6小时、12小时、18小时和24小时测量PMVP（均值±标准差）。对照组分别为25±5 mmHg、26±2 mmHg、27±3 mmHg和28±3 mmHg。多巴酚丁胺组分别为25±6 mmHg、24±3 mmHg、22±2 mmHg和18±5 mmHg。多巴酚丁胺组的PMVP随时间下降（p < 0.001），而对照组则没有变化。多巴酚丁胺组临床拔管平均时间从18小时缩短至12小时（p < 0.06）。我们得出结论，在接受体外循环的患者中，术后给予多巴酚丁胺可显著降低体外循环后的PMVP。这可能减少肺间质水肿和肺部并发症。
