Austin S M, Schreiner B F, Kramer D H, Shah P M, Yu P N
Circulation. 1976 Feb;53(2):364-9. doi: 10.1161/01.cir.53.2.364.
The acute hemodynamic effects of either ethacrynic acid or furosemide were studied in 27 patients who underwent diagnostic right and transseptal left heart catheterization. Twenth-three patients had postcapillary pulmonary hypertension secondary to isolated or predominant mitral stenosis. Of these, 21 patients were in New York Heart Association functional class III, and one each in class II and IV. In the remaining four patients pulmonary artery pressures were normal. Two patients had aortic stenosis and one each coronary artery disease and nonobstructive cardiomyopathy. All four patients were in class II. Cardiac index, pressures, and pulmonary blood volume (PBV) were measured in the control state and 20, 40, and 60 min after diuretic administration. Pulmonary extravascular fluid volume (PEV) was measured in the control state and at 60 min post drug infusion. A similar hemodynamic response was observed for each drug. Significant reductions in pulmonary artery and left atrial mean pressures, cardiac index, and plasma volume occurred over the one hour observation period and were accompanied by a significant duiresis. However, despite recutions in central pressures and blood flow, PBV, ev, and PEV/PBV remained unchanged, as did systemic arterial pressure. Since 23 of the subjects had postcapillary pulmonary hypertension it is postulated that the failure of PBV to decrease significantly despite significant decreases in pulmonary artery mean pressure is related to altered pressure volume characteristics in the pulmonary vascular bed in which the lung is operating on a steep portion of its pressure volume curve. The failure of the PEV to decrease supports the concept that the pulmonary extravascular space is relatively resistant to early decreases in pulmonary capillary pressure induced acutely. The failure of the pulmonary extravascular fluid volume to decrease despite a fall in plasma volume and pressures corresponds to the well recognized delay in resolution of radiologic evidence of pulmonary congestion.
对27例接受右心和经房间隔左心诊断性心导管检查的患者，研究了依他尼酸或呋塞米的急性血流动力学效应。23例患者因单纯性或主要为二尖瓣狭窄继发毛细血管后肺动脉高压。其中，21例患者为纽约心脏协会心功能Ⅲ级，1例为Ⅱ级，1例为Ⅳ级。其余4例患者肺动脉压正常。2例患者有主动脉狭窄，1例有冠状动脉疾病，1例有非梗阻性心肌病。所有4例患者均为Ⅱ级。在对照状态以及给予利尿剂后20、40和60分钟测量心排血指数、压力和肺血容量（PBV）。在对照状态以及药物输注后60分钟测量肺血管外液体积（PEV）。观察到每种药物有相似的血流动力学反应。在1小时观察期内，肺动脉和左心房平均压力、心排血指数和血浆容量显著降低，并伴有显著利尿。然而，尽管中心压力和血流降低，但PBV、ev和PEV/PBV保持不变，体循环动脉压也保持不变。由于23例受试者有毛细血管后肺动脉高压，因此推测尽管肺动脉平均压力显著降低，但PBV未能显著降低与肺血管床压力-容量特性改变有关，在该肺血管床中肺在其压力-容量曲线的陡峭部分运行。PEV未能降低支持了这样的概念，即肺血管外间隙对急性诱导的肺毛细血管压力早期降低相对有抵抗力。尽管血浆容量和压力下降，但肺血管外液体积未能降低，这与肺充血的放射学证据消退的公认延迟相一致。
