LINCS：L-精氨酸甲酯（一种一氧化氮合酶抑制剂）治疗难治性心源性休克的前瞻性随机研究。

LINCS: L-NAME (a NO synthase inhibitor) in the treatment of refractory cardiogenic shock: a prospective randomized study.

作者信息

Cotter Gad, Kaluski Edo, Milo Olga, Blatt Alex, Salah Ahmed, Hendler Alberto, Krakover Rikardo, Golick Ahuva, Vered Zvi

机构信息

The Cardiology Department, Assaf-Harofeh Medical Center, Zerifin, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

出版信息

Eur Heart J. 2003 Jul;24(14):1287-95. doi: 10.1016/s0195-668x(03)00193-3.

DOI:10.1016/s0195-668x(03)00193-3

PMID:12871685

Abstract

AIMS

To evaluate the effect of L-NAME (a nitric oxide synthase inhibitor) in the treatment of refractory cardiogenic shock.

METHODS AND RESULTS

We enrolled 30 consecutive patients with refractory cardiogenic shock (systolic blood pressure that deteriorated progressively to <100 mmHg during an acute coronary syndrome despite maximal percutaneous coronary revascularization, intra aortic balloon pump, and IV dopamine, furosemide and fluids treatment for at least 1h, accompanied by signs of peripheral hypoperfusion). Patients were randomized to supportive care alone (n=15, control group) or to supportive care in addition to L-NAME (1mg/Kg bolus and 1mg/Kg/h continuous IV drip for 5h n=15). Death at one month was 27% in the L-NAME group vs. 67% in the control group (p=0.008). Unaugmented mean arterial blood pressure at 24 h from randomization was 86+/-20 mmHg in the L-NAME group vs. 66+/-13 mmHg in the control group (p=0.004). Urine output increased at 24h by 135+/-78 cc/h in the L-NAME group vs a decrease of 12+/-87 cc/h in the control group (p<0.001). Time on IABP and time on mechanical ventilation were significantly shorter in the L-NAME group.

CONCLUSIONS

The results of the present study further support our previous observation that NO synthase inhibitors are beneficial in the treatment of patients with refractory cardiogenic shock.

摘要

目的

评估L - NAME（一种一氧化氮合酶抑制剂）治疗难治性心源性休克的效果。

方法与结果

我们连续纳入30例难治性心源性休克患者（急性冠状动脉综合征期间，尽管进行了最大程度的经皮冠状动脉血运重建、主动脉内球囊反搏以及静脉注射多巴胺、呋塞米和补液治疗至少1小时，收缩压仍逐渐恶化至<100 mmHg，并伴有外周灌注不足的体征）。患者被随机分为单纯支持治疗组（n = 15，对照组）或在支持治疗基础上加用L - NAME组（1mg/Kg静脉推注，然后1mg/Kg/h持续静脉滴注5小时，n = 15）。L - NAME组1个月时的死亡率为27%，而对照组为67%（p = 0.008）。随机分组后24小时时，L - NAME组未增强的平均动脉血压为86±20 mmHg，对照组为66±13 mmHg（p = 0.004）。L - NAME组24小时尿量增加135±78 cc/h，而对照组减少12±87 cc/h（p<0.001）。L - NAME组使用主动脉内球囊反搏的时间和机械通气的时间显著缩短。