Massie B M, Chatterjee K
Med Clin North Am. 1979 Jan;63(1):25-51. doi: 10.1016/s0025-7125(16)31715-1.
In patients with pump failure complicating acute infarction, vasodilating drugs, by reducing impedance to left ventricular outflow and venous return to the heart, improve cardiac performance without affecting myocardial contractility. Sodium nitroprusside currently is the vasodilator of choice in most patients with both elevated left ventricular filling pressures and reduced cardiac output. Patients with accompanying mechanical defects, such as acute mitral regurgitation or ventricular septal rupture, are particularly amenable to vasodilator therapy. Some patients may require combined therapy, with inotropic catecholamines or mechanical assistance devices together with vasodilators, in order to avoid undesirable hypotension. Side effects and toxicity are rare when patients are carefully selected and monitored. It is uncertain whether vasodilators reduce ischemia or salvage jeopardized myocardium, but they appear to improve the initial prognosis of some patients with severe pump failure. The long-term prognosis of these patients remains poor, however, and therefore a more aggressive approach to their chronic management seems warranted.
在急性心肌梗死并发泵衰竭的患者中，血管扩张药物通过降低左心室流出阻抗和心脏静脉回流，在不影响心肌收缩力的情况下改善心脏功能。目前，硝普钠是大多数左心室充盈压升高且心输出量降低患者的首选血管扩张剂。伴有机械性缺陷（如急性二尖瓣反流或室间隔破裂）的患者尤其适合接受血管扩张剂治疗。一些患者可能需要联合治疗，即使用正性肌力儿茶酚胺或机械辅助装置与血管扩张剂一起使用，以避免出现不良低血压。当仔细挑选和监测患者时，副作用和毒性很少见。血管扩张剂是否能减少缺血或挽救濒危心肌尚不确定，但它们似乎能改善一些严重泵衰竭患者的初始预后。然而，这些患者的长期预后仍然很差，因此似乎有必要对他们的慢性治疗采取更积极的方法。
