冠動脈バイパス術の人工心肺離脱時におけるオルプリノンの使用経験

The Effects of Olprinone on Hemodynamics in Patients Undergoing Cardiac Surgery

　冠動脈バイパス術（CABG）施行予定28例を対象に，人工心肺離脱時の循環動態に対するオルプリノンの効果を非使用群と比較検討した．14例に対しオルプリノン10μg／kgをボーラス投与後，0.1μg／kg／minを点滴静注した（オルプリノン群）．他の14例はオルプリノン非使用群（コントロール群）とした．血行動態は麻酔導入後，オルプリノン投与直後，投与5分後，10分後，人工心肺離脱直後，離脱15分後，30分後，60分後に測定した．オルプリノン群ではコントロール群に比べて人工心肺離脱直後から心係数の著明な増加を認め（p＜0.001），全身血管抵抗，肺血管抵抗は有意に低下した（各々p＜0.001）．一方，心拍数，平均動脈圧，肺動脈襖入圧は両群間で有意差を認めなかった．以上より，CABGにおいてオルプリノンは人工心肺からの離脱を容易にし，離脱後の血行動態の安定に有用であると考えられた．

Recently, phosphodiesterase III inhibitors have been developed and evaluated for their therapeutic potential in the treatment of acute heart failure. The hemodyna-mics of olprinone, a newly synthesized phosphodieste-rase III inhibitor, was investigated in cases of coronary artery bypass graft (CABG) on weaning from cardio-pulmonary bypass (CPB).

We studied consecutively 28 patients scheduled for CABG. Patients were assigned to the olprinone group (10μg･kg_-1 loading dose plus 0.1μg･kg_-1 min_-1 maintenance infusion ; n=14) or the control group (n-14). Dopamine and nitroglycerine were administered supplementarily in both groups. Olprinone was adminis-tered into the reservoir of CPB at rectal temperature 33.5°C. Hemodynamic data were obtained previously to CPB, at the point of administration, 5 minutes, and 10 minutes after olprinone administration, just after wean-ing from CPB, 15, 30, 60 minutes after weaning from CPB.