【罂粟摘要】米力农吸入与静脉注射在二尖瓣狭窄合并肺动脉高压患者术中的应用
米力农吸入与静脉注射在二尖瓣狭窄合并肺动脉高压患者术中的应用
评价和比较合并重度肺动脉高压患者行二尖瓣手术静脉注射和吸入米力农在两个时点的血流动力学效应。
对100例右室收缩压>50 mmHg的风湿性二尖瓣重度狭窄(伴/不伴返流)患者进行前瞻性观察研究。根据降低肺动脉高压的策略，他们被分为两组。50例患者在胸骨切开后吸入米力农，直到体外循环开始；主动脉阻断解除后，直到脱离体外循环。另50例在开放主动脉后10min内静注负荷剂量米力农50 μg·kg-1。两组均在体外循环脱机期间静脉注射米力农0.5 μg·kg-1。观察3个时点的血流动力学数据。
吸入米力农组的肺动脉压、中心静脉压和肺毛细血管楔压均显著低于静脉注射组。吸入米力农组的体循环阻力指数和心指数明显高于吸入组，肺血管阻力指数明显低于吸入组。静脉注射米力农组的平均动脉压与平均肺动脉压之比显著降低。吸入米力农组三尖瓣环平面收缩期离散度和右室面积变化明显增加。
术中吸入米力农可安全简便地应用于体外循环前后，明显改善右室血流动力学、右室功能和全身血流动力学。
Objective: To evaluate and compare the hemodynamic effects of intraoperative intravenous milrinone versus inhalational milrinone at two timepoints in patients with severe pulmonary hypertension undergoing mitral valve surgery.
Methods: A prospective observational study was performed in 100 patients with severe rheumatic mitral stenosis (with/without regurgitation) and right ventricular systolic pressure > 50 mm Hg. They were divided into two groups based on the strategy used to reduce pulmonary hypertension. Fifty patients had inhalational milrinone after sternotomy until initiation of cardiopulmonary bypass and after release of the aortic crossclamp until weaning off cardiopulmonary bypass. The other 50 patients received an intravenous loading dose of milrinone 50 μg.kg-1 over 10 min on release of the aortic crossclamp. Both groups received intravenous milrinone 0.5 μg.kg-1 during weaning from cardiopulmonary bypass. Hemodynamic data were evaluated at the 3 timepoints.
Results: Pulmonary artery pressures, central venous pressure, and pulmonary capillary wedge pressure decreased significantly in the inhalational milrinone group compared to the intravenous milrinone group. Systemic vascular resistance index and cardiac index were significantly higher and pulmonary vascular resistance index was significantly lower in the inhalational milrinone group. The mean arterial pressure-to-mean pulmonary artery pressure ratio was significantly lower in the intravenous milrinone group. Tricuspid annular plane systolic excursion and right ventricular fractional area change were increased significantly in the inhalational milrinone group.
Conclusion: Intraoperative inhalational milrinone before and after cardiopulmonary bypass is safe, easy to administer, and results in significant improvements in right ventricular hemodynamics, right ventricular function, and systemic hemodynamics.
翻译：郑振萍 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组