小剂量米力农对重症瓣膜病患者术后血流动力学的影响

目的观察小剂量米力农对重症瓣膜病患者术后血流动力学的影响，并评价此类药物的临床治疗效果。方法将拟行重症瓣膜置换手术的20例患者随机分成两组，A组为常规治疗组，B组在常规治疗基础上加用小剂量米力农，术前术后均用持续监测仪测定心指数(CI)、每搏指数(SⅥ)、外周阻力指数(SVRI)、肺血管阻力指数(PVRI)；用惠普多功能监测仪检测肺动脉平均压(MPAP)、肺动脉楔压(PAWP)。结果A、B两组术前各项血流动力学指标无明显差异，术后两组CI均较术前基础值明显升高，但B组的升高幅度超过A组；术后24h内B组平均动脉压(MAP)较术前下降明显，而A组下降不明显，两组相比有显著性差异(P＜0．05)；MPAP与PAWP变化与MAP相似；心率(HR)较术前增快，但两组间无显著性差异；术后SVRI，PVRI均较术前降低，B组较A组下降更明显，两组间比较有显著性差异(P＜0．05)。结论应用小剂量米力农可明显改善重症心脏瓣膜病患者手术后的心脏收缩功能，降低心脏前后负荷，增加心排量。

Effects of low-dosemilrinone on postoperative hemodynamics of severe valvular heart disease

Objective To examine the effects of low dose milrinone on postoperative hemodynamics of severe patients.Methods 20 patients scheduled for valve replacement were randomly divided into two groups.Regular therapy was given in Group A, while low dose milrinone was administered in patients after operation in Group B. Hemodynamics index such as CI, SVRI,PVRI etc. were determined by CCO monitor before and after operation.Results There was no significant difference between two groups in hemodynamics index before operation. Patients in two groups had an obvious increase in CI after operation, but Group B was higher than that of Group A. 24 hours after operation MAP decreased more significantly in Group B than in Group A; The changes in MPAP and PAWP were similar with MAP. HR in two groups was faster after operation, but there was no significant difference between the two groups. SVRI and PVRI decreased more markedly after operation in Group B than in Group A. Conclusion Applying low dose milrinone can improve hemodynamics and myocardial contractile function by decreasing SVR and PVR and increasing cardiac output.