Bailey J M, Miller B E, Kanter K R, Tosone S R, Tam V K
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30322-1101, USA.
Anesth Analg. 1997 Feb;84(2):294-8. doi: 10.1097/00000539-199702000-00010.
The phosphodiesterase inhibitor amrinone (AMR) increases cardiac output in children after cardiac surgery. In vitro, amrinone has both positive inotropic and vasodilatory effects. However the relative contribution of these effects to the increases in cardiac output observed clinically is unclear, and it has not been demonstrated that amrinone offers a hemodynamic advantage above that of pure vasodilators in infants. We compared the hemodynamic effects of AMR and sodium nitroprusside (SNP) in 10 infants after cardiac surgery. Cardiac index (CI) was measured by thermodilution after SNP administration, titrated to decrease mean blood pressure (MBP) by 20%, and then after a 1.5-mg/kg bolus dose of AMR. Each patient served as his or her own control. Preload, as measured by left atrial pressure and transesophageal echocardiography (in eight patients), was kept constant throughout the protocol. Both SNP and AMR caused significant decreases in MBP and systemic vascular resistance index (SVRI). However, only AMR resulted in a significant increase in CI. The ratio of fractional increase in CI to fractional absolute decrease in MBP was significantly greater for AMR than SNP, indicating greater efficacy for AMR in the treatment of low cardiac output syndrome and suggesting that, in infants after cardiac surgery, AMR has clinically relevant positive inotropic effects.
磷酸二酯酶抑制剂氨力农（AMR）可增加心脏手术后儿童的心输出量。在体外，氨力农具有正性肌力和血管舒张作用。然而，这些作用对临床上观察到的心输出量增加的相对贡献尚不清楚，并且尚未证明氨力农在婴儿中比单纯血管扩张剂具有血流动力学优势。我们比较了10例心脏手术后婴儿中AMR和硝普钠（SNP）的血流动力学效应。在给予SNP后通过热稀释法测量心脏指数（CI），滴定至平均血压（MBP）降低20%，然后在给予1.5mg/kg氨力农推注剂量后再次测量。每位患者均作为自身对照。在整个实验过程中，通过左心房压力和经食管超声心动图（8例患者）测量的前负荷保持恒定。SNP和AMR均导致MBP和体循环血管阻力指数（SVRI）显著降低。然而，只有AMR导致CI显著增加。AMR的CI分数增加与MBP分数绝对降低的比值显著大于SNP，表明AMR在治疗低心输出量综合征方面疗效更佳，并提示在心脏手术后的婴儿中，AMR具有临床上相关的正性肌力作用。
