米力农能逆转蛛网膜下腔出血后的脑血管痉挛

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Milrinone Reverses Cerebral Vasospasm After Subarachnoid Hemorrhage
NEW YORK (Reuters Health) Mar 11 - An infusion of milrinone, a phosphodiesterase inhibitor that combines vasodilating and inotropic properties, reverses the cerebral vasospasm that can accompany an aneurysmal subarachnoid hemorrhage (aSAH), French researchers report in the March issue of Stroke.
法国研究者在三月《中风》期刊上报道了他们的新发现：米力农（一种磷酸二酯酶抑制剂，具有舒张血管和影响肌肉收缩力的特性）能逆转动脉瘤致蛛网膜下腔出血后的脑动脉痉挛。（Stroke 2008;39:893-898）

\"All of our patients having a vasospasm are now treated during the angiogram by an intra-arterial injection of milrinone,\" Dr. Didier Payen of Hopital Lariboisiere in Paris told Reuters Health. \"Sometimes, catheters are kept in place intra-arterially to keep the milrinone infusing for up to 24 or 36 hours.\"
“我们所有的血管痉挛病人现在都在血管造影监测下接受血管内注射米力农的治疗，”巴黎Lariboisiere医院的 Didier Payen 博士告诉路透社健康专栏记者，“有时候，我们需要给病人留置输液管连续滴注米力农24到36小时。”

Dr. Payen and colleagues in Paris evaluated the efficacy of milrinone infusions in 22 consecutive patients with angiographically proven cerebral vasospasm and a reduction in arterial diameter of 40% or more.
Payen博士及其巴黎同事评估了血管内输注米力农的疗效：血管造影显示，有22名患者确诊为脑动脉痉挛，并且他们得血管直径缩小程度大于等于40％。

The investigators infused milrinone intra-arterially into the cerebral territories compromised by the vasospasm. The drug was then administered continuously by intravenous infusion for 14 days after the onset of the initial bleed.
研究者们将米力农注入受血管痉挛所影响的脑区的动脉中。在最初的蛛网膜下腔出血发作后14天时间里，研究者们仍对患者持续行控制性静脉给药。

\"Intra-arterial milrinone resulted in 53% increase in arterial diameter,\" the investigators report. \"Milrinone infusion resulted in a moderately increased heart rate, but systemic arterial pressure remained unchanged,\" they found.
“动脉注入米力农可使动脉直径增加53％，”该调查显示。“输注米力农虽然能轻度增加心率，但是全身动脉压并没有改变。”研究者们发现。

Five patients (23%) had angiographically-proven vasospasm recurrence within 48 hours after the procedure. Two were resolved successfully after a second intra-arterial infusion of milrinone and three underwent mechanical angioplasty.
有五名病人（占总人数的23％）经动脉造影证实在该疗程结束后48小时内复发血管痉挛。两名病人在第二次动脉内输注米力农后血管痉挛获得缓解，三名病人则常规接受了血管成型术。

Two patients died in the ICU and two were lost to follow-up, but all others had very good neurological outcomes at 1 year, the investigators report.
研究者们指出，有两名病人在ICU治疗中死亡，另有两名病人失访，但其他所有病人1年内具有良好的神经病学转归。

Milrinone treatment was tested because of its mechanism of action, Dr. Payen explained. \"It dilates vessels differently from other vasodilators, because it also combines cardiac performance improvement.\"
因为它对运动系统的作用，米力农的治疗还在试验阶段，Payen博士解释道，“它舒张血管的作用与其他血管舒张药物不同，因为它也能改进心功能。”

In addition, treatments such as nimodipine or papaverine frequently fail, as does so-called triple H treatment (hypervolemia, hypertension, hemodilution), he said. \"These never demonstrated any benefit in outcome or are associated with numerous side effects,\" including arrhythmia and hypokalemia.
除此之外，诸如尼莫地平或罂粟碱的治疗常常失效，所谓的“3H（高血容量，高血压，血液稀释）”的治疗也是如此，研究者指出：“这些治疗要么从未显示它们在疗效上的优势，要么就具有许多副作用，”其中包括心律不齐和低钾血症。

Dr. Payen said that although randomized trials are still needed, he and his colleagues are already using milrinone in selected patients with aneurysmal subarachnoid hemorrhage.
Payen博士指出，虽然仍需要随机试验来证实米力农的疗效，但是他和他的同事在动脉瘤致蛛网膜下腔出血的病人中已经选择性使用米力农。