【摘要】 目的评价正性肌力药米力农在治疗体外循环(CPB)心脏手术后心力衰竭所致低心排血量综合征时对患者肾脏的影响。方法选取2018年1月至2020年6月间在我院心胸外科治疗的CPB心脏手术患者,在患者心脏停跳后30 min(基线期)和60 min(治疗后)进行肾脏和全身血流动力学检测。CPB术后30 min发生低心排血量综合征患者接受米力农治疗,根据患者CPB心脏手术后是否应用米力农,将患者分为米力农组(n=59)和对照组(n=82)。比较两组患者血流动力学指标和肾血流动力学指标基线期值、治疗后值、治疗后较基线期变化值。比较治疗后两组患者预后指标及并发症发生率。结果治疗后米力农组患者心脏指数变化值[(0.55±0.26) L/(min·m~2) vs.(-0.35±0.28) L/(min·m~2),t=19.394,P <0.001]、心搏容量指数变化值(t=8.776,P <0.001)、氧释放系数变化值(t=8.143,P <0.001)、混合静脉血氧饱和度变化值(t=9.935,P <0.001)与对照组比较显著提高,周身血管阻力指数变化值(t=10.574,P <0.001)、肺血管阻力指数变化值(t=10.654,P <0.001)与对照组比较显著降低。治疗后米力农组患者肾血流量变化值[(117.30±153.82) m L/min vs.(-63.73±157.64) m L/min,t=6.795,P <0.001]、肾脏供氧量变化值(t=4.248,P <0.001)与对照组比较显著提高,肾小球滤过分数变化值(t=6.382,P <0.001)、肾血管阻力变化值[(-0.06±0.05) mm Hg/(m L·min) vs.(0.03±0.06) mm Hg/(m L·min),t=9.407,P <0.001]和肾氧摄取率变化值(t=7.625,P <0.001)与对照组比较显著降低。结论米力农在心脏手术后早期用于治疗急性心力衰竭所致低心排血量综合征,可以增加患者心输出量和肾血流量,扩张肾血管。米力农可以改善患者易感肾脏的氧合作用,但不会引起肾小球滤过率的显著变化。更多还原

【Abstract】 Objective To evaluate the effect of milrinone on the kidney of patients with low cardiac output syndrome caused by heart failure after cardiopulmonary bypass( CPB). Methods From January 2018 to June 2020,the patients with CPB undergoing cardiac surgery in Rizhao People’ s Hospital were selected and their renals and systemic hemodynamics were detected 30 minutes( baseline period) and 60 minutes( after treatment) after cardiac arrest. The patients with low cardiac output syndrome 30 minutes after CPB were treated with milrinone. The patients were divided into milrinone group( n = 59) and control group( n = 82). The baseline,post-treatment and change values of hemodynamic indexes and renal hemodynamic indexes were compared between the two groups. The prognosis and incidence rate of complications in the two groups were compared after the treatment.Results After the treatment,the variation value of cardiac index [( 0. 55 ± 0. 26) L/( min·m~2) vs.(-0. 35 ± 0. 28) L/( min·m~2),t = 19. 394,P < 0. 001],stroke volume index( t = 8. 776,P <0. 001),systemic oxygen delivery index( t = 8. 143,P < 0. 001) and mixed venous saturation( t = 9. 935,P < 0. 001) in milrinone group were significantly higher than those in the control group. The variation value of systemic vascular resistance index( t = 10. 574,P < 0. 001),pulmonary vascular resistance index( t = 10. 654,P < 0. 001) were significantly decreased in milrinone group compared with the control group. Compared with the control group,the variation value of renal blood flow [( 117. 30 ±153. 82) m L/min vs.(-63. 73 ± 157. 64) m L/min,t = 6. 795,P < 0. 001] and renal oxygen delivery( t = 4. 248,P < 0. 001) in milrinone group were significantly higher than those in the control group,while the variation value of glomerular filtration fraction( t = 6. 382,P < 0. 001),renal vascular resistance [(-0. 06 ± 0. 05) mm Hg/( m L·min) vs.( 0. 03 ± 0. 06) mm Hg/( m L·min),t = 9. 407,P < 0. 001] and renal oxygen extraction( t = 7. 625,P < 0. 001) in milrinone group were significantly lower than those in the control group. Conclusions Milrinone can increase cardiac output,renal blood flow and dilate renal vessels in the patients with acute heart failure. Milrinone can improve the oxygenation of susceptible kidneys,but it does not cause significant changes in glomerular filtration rate.更多还原