PDF(Pubmed)
Abstract：
BACKGROUND: Conventional anesthesia used to reduce central venous pressure (CVP) during hepatectomy includes fluid restriction and vasodilator drugs, which can lead to a reduction in blood perfusion in vital organs and may counteract the benefits of low blood loss. In this study, we hypothesized that milrinone is feasible and effective in controlling low CVP (LCVP) during laparoscopic hepatectomy (LH). Compared with conventional anesthesia such as nitroglycerin, milrinone is beneficial in terms of intraoperative blood loss, surgical environment, hemodynamic stability, and patients\' recovery.
METHODS: In total, 68 patients undergoing LH under LCVP were randomly divided into the milrinone group (n = 34) and the nitroglycerin group (n = 34). Milrinone was infused with a loading dose of 10 µg/kg followed by a maintenance dose of 0.2-0.5 µg/kg/min and nitroglycerin was administered at a rate of 0.2-0.5 µg/kg/min until the liver lesions were removed. The characteristics of patients, surgery, intraoperative vital signs, blood loss, the condition of the surgical field, the dosage of norepinephrine, perioperative laboratory data, and postoperative complications were compared between groups. Blood loss during LH was considered the primary outcome.
RESULTS: Blood loss during hepatectomy and total blood loss were significantly lower in the milrinone group compared with those in the nitroglycerin group (P < 0.05). Both the nitroglycerin group and milrinone group exerted similar CVP (P > 0.05). Nevertheless, the milrinone group had better surgical field grading during liver resection (P < 0.05) and also exhibited higher cardiac index and cardiac output during the surgery (P < 0.05). Significant differences were also found in terms of fluids administered during hepatectomy, urine volume during hepatectomy, total urine volume, and norepinephrine dosage used in the surgery between the two groups. The two groups showed a similar incidence of postoperative complications (P > 0.05).
CONCLUSIONS: Our findings indicate that the intraoperative infusion of milrinone can help in maintaining an LCVP and hemodynamic stability during LH while reducing intraoperative blood loss and providing a better surgical field compared with nitroglycerin.
BACKGROUND: ChiCTR2200056891,first registered on 22/02/2022.
METHODS: In total, 68 patients undergoing LH under LCVP were randomly divided into the milrinone group (n = 34) and the nitroglycerin group (n = 34). Milrinone was infused with a loading dose of 10 µg/kg followed by a maintenance dose of 0.2-0.5 µg/kg/min and nitroglycerin was administered at a rate of 0.2-0.5 µg/kg/min until the liver lesions were removed. The characteristics of patients, surgery, intraoperative vital signs, blood loss, the condition of the surgical field, the dosage of norepinephrine, perioperative laboratory data, and postoperative complications were compared between groups. Blood loss during LH was considered the primary outcome.
RESULTS: Blood loss during hepatectomy and total blood loss were significantly lower in the milrinone group compared with those in the nitroglycerin group (P < 0.05). Both the nitroglycerin group and milrinone group exerted similar CVP (P > 0.05). Nevertheless, the milrinone group had better surgical field grading during liver resection (P < 0.05) and also exhibited higher cardiac index and cardiac output during the surgery (P < 0.05). Significant differences were also found in terms of fluids administered during hepatectomy, urine volume during hepatectomy, total urine volume, and norepinephrine dosage used in the surgery between the two groups. The two groups showed a similar incidence of postoperative complications (P > 0.05).
CONCLUSIONS: Our findings indicate that the intraoperative infusion of milrinone can help in maintaining an LCVP and hemodynamic stability during LH while reducing intraoperative blood loss and providing a better surgical field compared with nitroglycerin.
BACKGROUND: ChiCTR2200056891,first registered on 22/02/2022.
摘要：
背景：用于在肝切除术中降低中心静脉压（CVP）的常规麻醉包括液体限制和血管舒张药物，这可能导致重要器官的血液灌注减少，并可能抵消低失血的好处。在这项研究中,我们假设米力农在腹腔镜肝切除术(LH)中控制低CVP(LCVP)是可行且有效的.与硝酸甘油等常规麻醉相比，米力农在术中出血方面是有益的，手术环境,血液动力学稳定性，和病人的康复。
方法：总共，将68例接受LCVP下LH的患者随机分为米力农组（n=34）和硝酸甘油组（n=34）。米力农以10µg/kg的负荷剂量输注，然后以0.2-0.5µg/kg/min的维持剂量输注，并以0.2-0.5µg/kg/min的速率施用硝酸甘油，直到肝脏病变被去除。患者的特点,手术,术中生命体征,失血,手术领域的状况，去甲肾上腺素的剂量,围手术期实验室数据，比较两组患者术后并发症。LH期间的失血被认为是主要结果。
结果：与硝酸甘油组相比，米力农组肝切除术中的失血量和总失血量明显减少（P<0.05）。硝酸甘油组和米力农组均表现出相似的CVP(P>0.05)。然而，米力农组肝切除时的术野分级较好（P<0.05），术中心指数和心输出量较高（P<0.05）。在肝切除术期间给药的液体方面也发现了显着差异，肝切除术期间的尿量，总尿量,两组手术中去甲肾上腺素的用量。两组术后并发症发生率相似(P>0.05)。
结论：我们的研究结果表明，与硝酸甘油相比，术中输注米力农有助于维持LH期间的LCVP和血流动力学稳定性，同时减少术中失血，并提供更好的手术视野。
背景：ChiCTR2200056891，于2022年2月22日首次注册。
方法：总共，将68例接受LCVP下LH的患者随机分为米力农组（n=34）和硝酸甘油组（n=34）。米力农以10µg/kg的负荷剂量输注，然后以0.2-0.5µg/kg/min的维持剂量输注，并以0.2-0.5µg/kg/min的速率施用硝酸甘油，直到肝脏病变被去除。患者的特点,手术,术中生命体征,失血,手术领域的状况，去甲肾上腺素的剂量,围手术期实验室数据，比较两组患者术后并发症。LH期间的失血被认为是主要结果。
结果：与硝酸甘油组相比，米力农组肝切除术中的失血量和总失血量明显减少（P<0.05）。硝酸甘油组和米力农组均表现出相似的CVP(P>0.05)。然而，米力农组肝切除时的术野分级较好（P<0.05），术中心指数和心输出量较高（P<0.05）。在肝切除术期间给药的液体方面也发现了显着差异，肝切除术期间的尿量，总尿量,两组手术中去甲肾上腺素的用量。两组术后并发症发生率相似(P>0.05)。
结论：我们的研究结果表明，与硝酸甘油相比，术中输注米力农有助于维持LH期间的LCVP和血流动力学稳定性，同时减少术中失血，并提供更好的手术视野。
背景：ChiCTR2200056891，于2022年2月22日首次注册。
