米力农对小儿心脏直视术后血液动力学的效应

Hemodynamic effects of Milrinone in pediatric patients after cardiac surgery

目的 探讨静脉米力农制剂对先心病术后患儿血液动力学的效应。方法 2 2例患儿随机分为 :用药组 15例 ,对照组 7例。观察 :(1)体、肺动脉压 (sAP/mAP、sPAP/mPAP)、右房压 (mRAP)、体、肺血管阻力(SVRI)、心排指数 (CI)、HR、率压指数 (RPI)的变化 ;(2 )不同静脉维持量的疗效。结果 (1)用药前 ,负荷后肺血管阻力指数 (PVRI)、mPAP降低 2 1.9%、13 .3 % ;SVRI、mRAP、mAP降低 2 1.4%、14.7%、8.1% ;CI和HR上升 16 .1%和 5 .8% (P <0 .0 1,P <0 .0 5 ) ,而RPI无明显变化。 (2 )对照B组 ,3种维持量均降低PVRI、SVRI,提高CI(P <0 .0 1) ,高剂量下PVRI、mPAP维持最低而CI、SI保持最佳 ,且中、高剂量对mAP无影响。 (3)心律失常和血小板下降发生率 9.1%。结论 米力农是治疗术后肺高压和低心排有效 。

Objective To investigate the hemodynamic effects of short term intravenous milrione in patients undergoing cardiac surgery. Methods 22 patients with pulmonary hypertension or potential low cardiac output were randomly devided into two groups:Group A( n =15); Group B( n =7). In both groups Milrinone 50 μg/kg was given in bolus, then 0.25, 0.5, 0.75 μg·kg -1 ·min -1 in Group A while normal saline was given in Group B as maintanence dose. Variables as baseline dose, loading dose were administered over 15 minutes, 30, 60, 90 minutes after infusion and 90 minutes after cessation were measured. Results Compared with the baseline dose and after loading dose, milrinone markedly increased CI, SI and HR (+16.1%,+8.9%,+5.8%), decreased PVRI and SVRI (-21.9%,-21.4%), lowered mRAP, mPAP and TPG (-14.7%, -13.3%, -7.8%), but without alteration in RPI ( P> 0.05) . Compared with placebo treatment, milrinone 50 μg/kg followed by 0.5～0.75 μg·kg -1 ·min -1 was effective in improving CI and 0.75 μg/kg·min was more favorable in lowering PVRI, mPAP while hymodynamic changes fell to the levcl of the placebo group. During administration, the total effective rate was 90.9%. The incidence of thrombocytopenia and arrhythmia in both were 9.1%. Conclusion Milrinone can improve cardiac output and decrease the vascular resistance particularly in relaxation of pulmonary artery without increasing the cardiac oxygen consumption, also, being effective and relatively safe.