围麻醉期静注米力农对心脏病手术患者血流动力学的影响

Hemodynamic effects of Milrinone in serious heart disease patients undergoing operation throughout the process of anesthesia.

目的观察米力农用于重症心脏病手术患者围麻醉期血流动力学改变。方法 2 0例重症心脏病手术患者(14例风湿性心脏病患者,6例法乐氏四联征患者),随机分 2组:组I麻醉诱导前米力农 5 0 μg·kg-1静注,继以 5 0 μg·kg-1min-1维持。组II给以等量生理盐水,观察给负荷量米力农前后,麻醉诱导后,锯胸后CPB结束时,关胸前血流动力学指标变化及主动脉阻断开放后 15、30、6 0、90min的多巴胺的用量。结果 (1)组Ⅰ与组Ⅱ相比,CI、LVSWI明显升高( P <0 0 5 )。PAWP、SVR明显降低(P <0 0 5 ),MBP、HR无明显变化( P >0 0 5 )。(2)组I在主动脉开放后多巴胺的用量少于组Ⅱ( P <0 0 5 )。结论米力农可显著增加心脏收缩力。

Objective To evaluate the hemodynamic effects of Milrinone in serious heart disease patients undergoing operation throughout the process of anesthesia . Methods Twenty serious heart disease patients ( 16 cases undergoing valve replacement , 4 cases Fallot's tetralogy ) were randomized into group I ( n-10 ) and group II ( n-10 ) . Before induction of general anesthesia, Milrinone was administered at a 50μg·kg -1 bolus dose intravenously , followed by a continueous infusion of 50μg·kg -1·min -1 in group I , and the same volume of normal saline in group II . The data of hemodynamics were obtained at the following points : before and after loading dose of Milrinone , after induction of general anesthesia , after opening the chest , after weaning of CPB and before shutting the sterum . The dosage of Dopamine at 15,30,60,90 min time point after heart rebeat was recorded . Results (1)After loading dose of Milrinone, CI, LVSWI were significantly higher , while PAWP, SVR were significantly lower(P<0.05)in group I than in group II,but MBP,HR had no obvious changement(P>0.05). (2) The dosage of Dopamine in group I is lower than in group II after heart rebeation . Conclusion Administration of milrinone can effectively increase cardiac output and left ventricular stroke work , and decrease pulmonary artery pressure , pulmonary and system vascular resistance .