米力农对二尖瓣置换术后低心排患者血液动力学的影响

Hemodynamic effects of milrinone in the treatment of low cardiac output after mitral valve replacement surgery

目的 评价国产米力农对二尖瓣置换术后低心排患者血液动力学改变的临床效果。方法 2 0例行二尖瓣置换术患者 ,随机均分为两组 :M组 ,米力农 5 0μg· kg- 1 静注 ,以 0 .5μg· kg- 1 ·min- 1 维持 ;C组 (对照组 ) ,等量生理盐水。观察给药前、给药后 5、15、30、6 0分两组 HR、MAP、PCWP、CI、SVR、PVR、SVI和 L SWI的变化。结果 M组给药后 CI、SVI、L VSWI明显增高 (P<0 .0 5 ) ,PCWP、SVR明显降低 (P<0 .0 5 ) ,C组上述数据给药后无明显改变 (P>0 .0 5 )。与 C组比较 ,M组 CI给药后 5分增高极显著 (P<0 .0 1) ,30分仍显著增高 (P<0 .0 5 ) ,PCWP给药后 5、6 0分显著降低 (P<0 .0 5 ) ,SVR给药后 15分降低极显著 (P<0 .0 1) ,30分仍显著降低 (P<0 .0 5 )。结论 米力农可显著增加心脏指数 ,降低前、后负荷。

Objective To evaluate the hemodynamic effects of milrinone in patients after mitral valve replacement.Methods Twenty patients undergoing mitral valve replacement were studied.Immediately after removal aortic cannulation,patients were randomly divided into two groups:group M(n=10):milrinone 50μg·kg -1 +0.5μg·kg -1 ·min -1 intravenously,group C(n=10): normal saline.HR,MAP,PCWP,CI,SVR,SVI and LVSWI were monitored before administration and 5,15,30 and 60 min after administration.Results After administration,CI,SVI and LVSWI in group M were significantly higher than baselines(P<0.05).PCWP and SVR were significantly lower than baselines(P<0.05).There were no changes in group C(P>0.05).Compared with those in group C,in group M CI increased significantly 5 min after administration(P<0.01), still remained higher level 30 min after administration(P<0.05),PCWP decreased 5 and 60 min after administration (P<0.05),and SVR reduced significantly 15 min after administration(P<0.01),was still kept lower level 30 min after administration(P<0.05).Conclusion Milrinone can effectively improve cardiac index,decrease preload and afterload.