Hemodynamic changes during off-pump coronary artery bypass anastomosis in patients with coexisting mitral regurgitation: Improvement with milrinone
Hemodynamic changes during off-pump coronary artery bypass anastomosis in patients with coexisting mitral regurgitation: Improvement with milrinone
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DOI：
10.1213/01.ane.0000155262.37491.6a
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发表时间：
2005-07-01
影响因子：
5.7
通讯作者：
Sakata, R
中科院分区：
文献类型：
--
作者：
Omae, T;Kakihana, Y;Sakata, R
我们假设在非体外循环冠状动脉搭桥（OPCAB）吻合过程中，伴有二尖瓣返流（MR）的患者会加重，心脏指数（Cl）降低，平均肺动脉压（MPAP）升高，而米力农可以改善OPCAB吻合过程中MR的升高。140例选择性OPCAB患者分为三组：无MR组（MR（-）组）；n = 57), W (MR（+）组；n = 41)， MR患者接受米力农治疗(M+W（+）组；N = 42)。MR为1+或2+级的患者被纳入，MR为3+或4+级的患者被排除。在麻醉诱导后和吻合时测量血流动力学变量。M+MR（+）组麻醉诱导后立即静脉滴注米力酮(0.5 μ g(.) kg(-1) （.) min(-1)）。与MR（-）组相比，MR（+）组左冠状动脉吻合时Cl显著降低（P < 0.0001）， MPAP和MR显著升高（P < 0.001）。与MR（+）组相比，M+MR（+）组左冠状动脉吻合时MPAP和MR均未升高（P < 0.05）。在NIR患者中，左冠状动脉分支吻合与Cl降低、反流和MPAP增加有关。在这类患者中，米力农治疗有助于稳定吻合期间的血流动力学。
We hypothesized that mitral regurgitation (MR) would be exacerbated, cardiac index (Cl) decreased, and mean pulmonary artery pressure (MPAP) increased in patients with coexisting MR during off-pump coronary artery bypass (OPCAB) anastomosis, and that milrinone could ameliorate increases in MR that occur during OPCAB anastomosis. Subjects comprised 140 patients scheduled for elective OPCAB divided into three groups: patients without MR (MR(-) group; n = 57), patients with W (MR(+) group; n = 41), and patients with MR who received milrinone (M+W(+) group; n = 42). Patients with grade 1+ or 2+ MR were included, whereas those with grade 3+ or 4+ MR were excluded. Hemodynamic variables were measured after the induction of anesthesia and during anastomosis. IV infusion of milrinone (0.5 mu g (.) kg(-1) (.) min(-1)) started immediately after the induction of anesthesia in the M+MR(+) group. Cl was significantly decreased (P < 0.0001), and MPAP and MR were significantly increased (P < 0.001) during left coronary anastomosis in the MR(+) group compared with the MR(-) group. Cl was significantly higher (P < 0.001), and neither MPAP nor MR were increased (P < 0.05) during left coronary artery anastomosis in the M+MR(+) group compared to the MR(+) group. In patients with NIR, anastomosis of the left coronary artery branches was associated with decreased Cl and increased regurgitation and MPAP. In such patients, treatment with milrinone helps to stabilize hemodynamics during anastomosis.