폐동맥고혈압 환자에서 Amrinone이 전신 및 폐순환에 미치는 영향

Abstract

BACKGROUND: Amrinone is a noncatecholamine, nonglycoside agent with both inotropic and vasodilatory properties and therefore seems suitable for therapy of right ventricular(RV) dysfunction. The effects of amrinone on systemic and pulmonary hemodynamics in patients with secondary pulmonary hypertension were evaluated. METHODS: With IRB(Institutional Review Board) approval, 21 patients with pulmonary hypertension whose mean pulmonary arterial pressure(mPAP) was greater than 30 mmHg consented to participate in this prospective study. After the sternotomy under the steady state of anesthesia with fentanyl and low concentration of isoflurane, hemodynamic variables including heart rate, systemic arterial pressure(SAP), PAP, cardiac output were measured as control values. Patients recieved an initial bolus dose(1.0 mg/kg) of amrinone followed by a continuous infusion(7.5 mcq/kg/min) for 30 minutes. Hemodynamic variables were measured at 10 minutes and 30 minutes after the start of the continuous infusion. RESULTS: Amrinone reduced SAP and PAP and vascular resistance without tarchycardia. There was no significant change of cardiac output. Ratio of mPAP to mean SAP was decreased after the administration of amrinone. CONCLUSIONS: In cases of chronic RV failure with pulmonary hypertension, amrinone is especially useful because it improve cardiac performance without tarchycardia and reduce RV afterload. Indeed in this study, the fact that amrinone decreased SAP and systemic vascular resistance but reduced PAP and pulmonary vascular resistsnce more significantly(p<0.01) was revealed.