米力农不同给药方式在心脏瓣膜置换术中的临床应用观察

Clinical assessment of two regimens of milrinone infusion in patients undergoing valve replacement surgery

目的 观察体外循环下心脏瓣膜置换术中米力农不同给药方式对患者心功能和血流动力学指标的影响。方法 选择浙江省人民医院2019年9月至2021年6月美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级行心脏瓣膜置换术患者50例,根据随机数字表法分为早期持续小剂量给药组(R组)和常规给药组(C组),每组25例。R组在体外循环开始使用米力农0.375μg/(kg·min)持续维持,一直到手术结束;C组在主动脉开放后15 min内静脉注射米力农50μg/kg,之后以0.375μg/(kg·min)持续维持。观察患者术前、脱离体外循环时、手术结束时的心率、平均动脉压(MAP)和左心室射血分数(LVEF)等心功能和血流动力学指标变化。结果两组患者术前的MAP比较差异无统计学意义(P>0.05)。在手术结束时,R组患者的MAP高于C组(P<0.05)。R组体外循环后并行时间、脱离体外循环时的LVEF与C组比较差异均有统计学意义(均P<0.05),C组中有60.0%患者需要使用去甲肾上腺素,与R组比较差异有统计学意义(P<0.05)。结论 术中早期使用米力农可在脱离体外循环时增加LVEF,减少去甲肾上腺素支持的需求,使血流动力学指标更加稳定。

Objective To compare the effect of two different regimens of milrinone infusion on the cardiac function and perioperative hemodynamics in patients undergoing valve replacement surgery. Methods Fifty patients scheduled for valve replacement surgery in Zhejiang Provincial People’s Hospital from September 2019 to June 2021 were randomly assigned into two groups with 25 cases in each group. In group R, 0.375 μg/(kg·min)milrinone was given at the begging of CPB and maintained during the whole period of surgery;in group C, milrinone was started with a loading dose of 50 μg/kg over 15 min before weaning from CPB followed by infusion 0.375 μg/(kg·min) during the cardiac surgery. Intraoperative heart rate(HR), mean arterial pressure(MAP) and left ventricular ejection fraction(LVEF)were documented. Results There was no significant difference in the MAP(P>0.05) between the two groups when weaning from CPB. The MAP was lower in group C than that in group R at the end of surgery(P<0.05).The LVEF was lower in group C than that in group R(P<0.05)when weaning from CPB. The time from aortic cross-clamp removal to weaning from CPB was shorter in group R than that in group C(P<0.05). Higher proportion of patients in group C required norepinephrine support than that in group R(P<0.05). Conclusion Early use of milrinone during procedure can increase the left ventricular ejection fraction when weaning from CPB and decrease the requirement for norepinephrine support, resulting a more stable perioperative hemodynamicsin in patients undergoing valve replacement surgery.