Effects of dobutamine on right ventricular function and pulmonary circulation in pulmonary hypertension during liver transplantation
Effects of dobutamine on right ventricular function and pulmonary circulation in pulmonary hypertension during liver transplantation
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DOI：
10.1016/j.transproceed.2005.10.045
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发表时间：
2005-11-01
影响因子：
0.9
通讯作者：
Parrilla, P
中科院分区：
文献类型：
--
作者：
Acosta, F;Sansano, T;Parrilla, P
导言。在原位肝移植(OLT)中，肺动脉高压(PH)影响右心(RV)功能。当右室衰竭发生时，减少右室后负荷，优化右室前负荷，并通过维持全身血压来保护冠脉血流灌注是术中治疗的主要目标。为了验证多巴酚丁胺对RV功能和RV-动脉偶联的影响，我们对9例接受OLT治疗的轻度PH患者和20例平均肺动脉压(MPAP)正常的患者进行了比较。所有患者在无肝期给予多巴酚丁胺5~10mU g/kg/min维持心脏指数(CI)和GT；3 L/分钟/m(2)。在多巴酚丁胺输注前和输注期间使用肺动脉导管进行血流动力学检查，研究MPAP、CI和右室舒张末容量指数(RVEDVI)。计算右室每搏做功指数(RVSWI)、右室收缩末期弹性(EES)、肺有效弹性(EA)和RV-动脉偶联效率(EES/EA)。PH组的右室收缩功能(EES和RVSWI)和后负荷(Ea)显著高于对照组。两组应用多巴酚丁胺后，所有研究变量均有改善：右室收缩功能增强，后负荷降低，EES/EA偶联明显增强。接受原位肝移植的轻度PH的肝硬变患者仍保留右室收缩功能和肺血管扩张功能。
Introduction. In the setting of orthotopic liver transplantation (OLT), pulmonary hypertension (PH) affects right ventricular (RV) function. When RV failure occurs, reducing RV afterload, optimizing RV preload, and preserving coronary perfusion through maintenance of systemic blood pressure are the primary goals of intraoperative treatment.Patients and methods. To verify the effect of dobutamine on RV function and RV-arterial coupling, we compared a group of 9 cirrhotic patients with mild PH treated with OLT to a group of 20 patients with normal mean pulmonary artery pressure (MPAP). All patients received dobutamine (5-10 mu g/kg/min) to maintain a cardiac index (CI) > 3 L/min/m(2), during the anhepatic phase. Hemodynamic profile, using a pulmonary artery catheter, was performed before and during dobutamine infusion, studying MPAP, Cl, and RV end-diastolic volume index (RVEDVI). RV stroke work index (RVSWI), RV end-systolic elastance (Ees), pulmonary effective elastance (Ea), and RV-arterial coupling efficiency as the Ees/Ea ratio were also calculated.Results. RV contractility (Ees and RVSWI) and afterload (Ea) were significantly higher among the PH group. In both groups, all the studied variables improved with dobutamine: RV contractility increased, afterload decreased, and thus Ees/Ea coupling markedly increased.Conclusion. Cirrhotic patients with mild PH who were undergoing OLT still have a reserve of RV contractile performance and pulmonary vasodilation.