米力农对非体外循环冠脉旁路移植术中血流动力学作用的临床观察

The Effect of Milrinone on Hemodynamics During Off-pump Coronary Artery Bypass Grafting

目的 :回顾性研究米力农对非体外循环冠脉旁路移植术 (OPCAB)中血流动力学的作用。方法 :连续 51例OPCAB病人术中使用米力农 ,其中有不稳定性心绞痛 8例 ,急性心梗 15例 ,心梗距手术时间 30 0± 2 6 1d。并充血性心衰 9例 ,肺动脉高压 12例。其中左主干狭窄者 10例 ,狭窄度为 70 9± 2 7 6 % ,三支病变 4 2例。全组左室射血分数 (LVEF) 4 1 7±13 0 %。术中先静脉注射一负荷量 ( 50 μg kg)米力农 ,然后滴注维持量 ( 0 5μg kg min)至手术结束。记录 (或计算 )米力农使用前后平均动脉压 (MAP)、中心静脉压 (CVP)、心率 (HR)和其它血管活性药物剂量。结果 :与使用前相比 ,米力农使用后MAP显著升高 ,CVP和HR显著降低 ,而其它三种血管活性药物剂量均无明显变化。手术时间 179 4± 37 1min,无手术死亡。结论 :米力农能稳定OPCAB术中血流动力学 。

Objective: To study retrospectively the effect of milrinone on h emodynamics during off-pump coronary artery bypass grafting (OPCAB). Meth ods: Milrinon e was administered in intra-operatively consecutive 51 OPCAB patients. These pa t ients comprised, but not mutually exclusive、 8 unstable angina、 15 acute myoca rd ial infarction (AMI) (which were operated on day 30.0±26.1 after onset of AMI) 、 9 congestive heart failure and 12 pulmonary hypertension. Ten patients had left m ain stenosis of 70.9±27.6% severity; 42 patients had triple vessel disease. The av erage left ventricle ejection fraction (LVEF) was 41.7±13.0%. Milrinone was inj ected intravenously with a loading dose of 50μg/kg followed by a continuous inf usion of 0.5μg/kg/min to the end of procedure. The mean artery pressure(MAP), c e ntral venous pressure (CVP), heart rate(HR) and doses of other three vasoactive drugs before and after milrinone administration were recorded or calculated res pectively. Results: Milrinone increased MAP, and decreased CVP and HR significan tly, compared with that before milrinone use. The doses of other three vasoactiv e drugs before and after milrinone administration did not change significantly. The operating time was 179.4±37.1 minutes, with no operative death. Conc lusion: Milrinone stabilizes intra-operatively hemodynamics of OPCAB, which is beneficia l for the operation and post-operational recovery.