Rathmell J P, Prielipp R C, Butterworth J F, Williams E, Villamaria F, Testa L, Viscomi C, Ittleman F P, Baisden C E, Royster R L
Department of Anesthesiology, University of Vermont College of Medicine, Burlington 05401, USA.
Anesth Analg. 1998 Apr;86(4):683-90. doi: 10.1097/00000539-199804000-00001.
Amrinone and milrinone are phosphodiesterase inhibitors with positive inotropic effects useful for the treatment of ventricular dysfunction after cardiac surgery. Forty-four patients undergoing elective cardiac surgery at four centers received either amrinone (n = 22) or milrinone (n = 22) in a randomized, blind fashion. Immediately after separation from cardiopulmonary bypass (CPB), two bolus doses of either amrinone 0.75 mg/kg or milrinone 25 microg/kg were administered over 30 s, separated by 5 min. Hemodynamic measurements were recorded before each dose and at the end of the 10-min study. Both amrinone and milrinone increased the cardiac index (48% vs 52%, P = not significant [NS] for amrinone and milrinone, respectively). There was a small increase in mean arterial pressure (MAP) after amrinone administration (from 68 +/- 3 to 72 +/- 3 mm Hg at 10 min, P < 0.05) with no significant change in MAP after milrinone administration. Central venous pressure was significantly higher in the amrinone group at baseline and 5 min (12 vs 10 mm Hg and 11 vs 10 mm Hg, respectively; P < 0.05). Systemic and pulmonary vascular resistances decreased significantly and to a similar extent after either amrinone or milrinone administration. Phenylephrine was required in 11 of 22 patients receiving amrinone and in 11 of 22 patients receiving milrinone to maintain arterial blood pressure. The proportion of patients requiring an intravascular volume infusion (15 of 22 vs 17 of 22, P = NS) and the total fluid volume infused were similar (402 +/- 57 vs 350 +/- 49 mL, P = NS for amrinone and milrinone, respectively). Amrinone and milrinone seem to have similar hemodynamic effects after CPB, with the exception of blood pressure, although the need for vasopressor support of blood pressure did not differ. Selection between these two drugs may include nonhemodynamic considerations such as cost.
Amrinone and milrinone are drugs that improve cardiac contraction. Their effects have never been directly compared in patients. We found that amrinone and milrinone produced similar hemodynamic effects in adult patients undergoing cardiac surgery. Choice between the two drugs can be based on nonhemodynamic considerations such as cost.
氨力农和米力农是磷酸二酯酶抑制剂，具有正性肌力作用，可用于治疗心脏手术后的心室功能障碍。四个中心的44例接受择期心脏手术的患者以随机、盲法的方式接受了氨力农（n = 22）或米力农（n = 22）治疗。在脱离体外循环（CPB）后立即在30秒内给予两剂负荷剂量的氨力农0.75mg/kg或米力农25μg/kg，间隔5分钟。在每次给药前和10分钟研究结束时记录血流动力学测量值。氨力农和米力农均增加了心脏指数（氨力农和米力农分别为48%对52%，P =无显著性差异[NS]）。氨力农给药后平均动脉压（MAP）有小幅升高（10分钟时从68±3mmHg升至72±3mmHg，P<0.05），而米力农给药后MAP无显著变化。氨力农组基线和5分钟时中心静脉压显著更高（分别为12对10mmHg和11对10mmHg；P<0.05）。氨力农或米力农给药后全身和肺血管阻力均显著降低且程度相似。接受氨力农的22例患者中有11例和接受米力农的22例患者中有11例需要去氧肾上腺素来维持动脉血压。需要血管内容量输注的患者比例（22例中的15例对22例中的17例，P = NS）和输注的总液体量相似（氨力农和米力农分别为402±57对350±49mL，P = NS）。CPB后氨力农和米力农似乎具有相似的血流动力学效应，但血压除外，尽管维持血压所需的血管升压药支持无差异。这两种药物之间的选择可能包括非血流动力学因素，如成本。
氨力农和米力农是改善心脏收缩的药物。它们的作用从未在患者中直接比较过。我们发现氨力农和米力农在接受心脏手术的成年患者中产生相似的血流动力学效应。两种药物之间的选择可以基于非血流动力学因素，如成本。
