Orime Y, Shiono M, Hata H, Yagi S, Tsukamoto S, Kimura S, Ohmiya S, Sezai A, Yamada H, Obana M, Sezai Y
Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Sep;46(9):803-9. doi: 10.1007/BF03217826.
To estimate the effectiveness of concomitant usage of milrinone and catecholamine for weaning from cardiopulmonary bypass (CPB), a clinical study was made, in elective coronary artery bypass grafting (CABG) cases. 24 consecutive patients underwent elective CABG in our institute. In all cases, moderate hypothermia and cardioplegic(St. Thomas solution) cardiac arrest were performed. In 12 cases, continuous intravenous 0.25 microgram/kg/min of milrinone, 3 micrograms/kg/min of dobutamine (DOB) and dopamine (DOA) as the initial doses, were used concomitantly as inotropic agents (Group-I). The same initial doses of catecholamine (DOB and DOA) as the Group-I were administered in another 12 patients (Group-II). When the pump flow of CPB decreased to a half, these drugs were administered in both groups. Hemodynamic data were measured before CPB, just after operation, 3, 6, 12, 24, 48, and 72 hours after operation. There were no significant differences in aortic and pulmonary artery pressure between both groups. However, cardiac index (CI) of the Group-I demonstrated significantly (p < 0.01) higher values than that of Group-II until 24 hours after surgery. Systemic vascular resistance index (SVRI) of the Group-I demonstrated significantly (p < 0.01) lower value than that of Group-II from 3 to 12 hours after operation. There were no significant differences in oxygen delivery (DO2) and oxygen consumption (VO2) between both groups. These results suggested that concomitant usage of milrinone and low dose catecholamine increased CI and decreased SVRI, and made weaning from CPB very easy, demonstrating excellent hemodynamics. This high potential phosphodiesterase inhibitor may be suitable for not only weaning from CPB but also post-cardiotomy cardiogenic shock.
为评估米力农与儿茶酚胺联合使用对体外循环（CPB）撤机的有效性，我们对择期冠状动脉旁路移植术（CABG）患者进行了一项临床研究。我院连续24例患者接受了择期CABG手术。所有病例均采用中度低温和心脏停搏（圣托马斯溶液）。12例患者术中持续静脉输注初始剂量为0.25微克/千克/分钟的米力农、3微克/千克/分钟的多巴酚丁胺（DOB）和多巴胺（DOA）作为强心剂（第一组）。另外12例患者（第二组）给予与第一组相同初始剂量的儿茶酚胺（DOB和DOA）。当CPB泵流量降至一半时，两组均给予这些药物。在CPB前、术后即刻、术后3、6、12、24、48和72小时测量血流动力学数据。两组间主动脉和肺动脉压力无显著差异。然而，直到术后24小时，第一组的心脏指数（CI）显著高于第二组（p<0.01）。术后3至12小时，第一组的全身血管阻力指数（SVRI）显著低于第二组（p<0.01）。两组间氧输送（DO2）和氧消耗（VO2）无显著差异。这些结果表明，米力农与低剂量儿茶酚胺联合使用可增加CI并降低SVRI，使CPB撤机非常容易，显示出良好的血流动力学。这种高潜力的磷酸二酯酶抑制剂不仅适用于CPB撤机，也适用于心脏术后心源性休克。
