Al-Hesayen Abdul, Azevedo Eduardo R, Newton Gary E, Parker John D
Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
J Am Coll Cardiol. 2002 Apr 17;39(8):1269-74. doi: 10.1016/s0735-1097(02)01783-7.
The goal of this work was to study the effects of short-term infusion of dobutamine on efferent cardiac sympathetic activity.
Increased efferent cardiac sympathetic activity is associated with poor outcomes in the setting of congestive heart failure (CHF). Dobutamine is commonly used in the therapy of decompensated CHF. Dobutamine, through its effects on excitatory beta-receptors, may increase cardiac sympathetic activity.
Seven patients with normal left ventricular (LV) function and 13 patients with CHF were studied. A radiotracer technique was used to measure cardiac norepinephrine spillover (CANESP) before and during an intravenous infusion of dobutamine titrated to increase the rate of rise in LV peak positive pressure (+dP/dt) by 40%.
Systemic arterial pulse pressure increased significantly in response to dobutamine in the normal LV function group (74 +/- 3 mm Hg to 85 +/- 3 mm Hg, p = 0.005) but remained unchanged in the CHF group. Dobutamine caused a significant decrease in LV end-diastolic pressure in the CHF group (14 +/- 2 mm Hg to 11 +/- 2 mm Hg, p = 0.02), an effect not observed in the normal LV group. In the normal LV function group, CANESP did not change in response to dobutamine (75 +/- 22 pmol/min vs. 72 +/- 22 pmol/min, p = NS). In contrast, dobutamine infusion was associated with a significant reduction in CANESP in patients with CHF (199 +/- 43 pmol/min to 128 +/- 30 pmol/min, p < 0.0009).
Dobutamine infusion caused a significant sympatholytic response in patients with CHF. This sympathetic withdrawal response is probably related to reduction of LV filling pressures and/or activation of ventricular mechanoreceptors with dobutamine infusion.
本研究旨在探讨短期输注多巴酚丁胺对心脏传出交感神经活动的影响。
在充血性心力衰竭（CHF）患者中，心脏传出交感神经活动增强与不良预后相关。多巴酚丁胺常用于失代偿性CHF的治疗。多巴酚丁胺通过作用于兴奋性β受体，可能会增加心脏交感神经活动。
对7例左心室（LV）功能正常的患者和13例CHF患者进行研究。采用放射性示踪技术，在静脉输注多巴酚丁胺滴定至使LV峰值正压上升速率（+dP/dt）增加40%之前和期间，测量心脏去甲肾上腺素溢出率（CANESP）。
在左心室功能正常组，多巴酚丁胺使体动脉脉压显著升高（从74±3 mmHg升至85±3 mmHg，p = 0.005），而在CHF组则保持不变。多巴酚丁胺使CHF组的LV舒张末期压力显著降低（从14±2 mmHg降至11±2 mmHg，p = 0.02），这一效应在左心室功能正常组未观察到。在左心室功能正常组，多巴酚丁胺对CANESP无影响（75±22 pmol/min对72±22 pmol/min，p =无统计学意义）。相反，在CHF患者中，输注多巴酚丁胺与CANESP显著降低相关（从199±43 pmol/min降至128±30 pmol/min，p < 0.0009）。
输注多巴酚丁胺在CHF患者中引起显著的交感神经抑制反应。这种交感神经撤离反应可能与输注多巴酚丁胺后LV充盈压降低和/或心室机械感受器激活有关。
