Verma S P, Silke B, Reynolds G W, Richmond A, Taylor S H
University Department of Cardiovascular Studies, General Infirmary, Leeds, U.K.
J Cardiovasc Pharmacol. 1992 Jan;19(1):24-33. doi: 10.1097/00005344-199201000-00004.
The effects of four inotropic agents with differing ancillary properties [a cardiac glycoside (digoxin), a combined alpha- and beta-adrenergic agonist (dobutamine), a beta-adrenergic agonist (prenalterol), and a phosphodiesterase inhibitor (amrinone)] alone and with subsequent addition of isosorbide dinitrate were compared in 48 consecutive acute myocardial infarction patients with radiographic and haemodynamic (pulmonary artery occluded pressure greater than 18 mm Hg) left ventricular failure. All agents with the exception of dobutamine reduced the elevated left heart filling pressure; only digoxin and dobutamine augmented the cardiac stroke volume index. All drugs except digoxin reduced the SVRI; an arteriolar constrictor response was evident 60 min after digoxin and a tachycardia resulted after combined alpha- and beta- and beta-adrenergic stimulations (dobutamine and prenalterol, respectively). The addition of isosorbide dinitrate reversed the inotrope-induced elevations of systemic arterial pressure and resulted in additional reductions in left heart filling pressure. These data suggest that, in the absence of substantial venodilator properties in an inotropic compound, reduction in elevated left heart filling pressure is not achieved with inotropic therapy alone in acute left ventricular failure and combining a venodilator may be haemodynamically advantageous.
在48例连续性急性心肌梗死合并影像学及血流动力学（肺动脉闭塞压大于18 mmHg）左心室衰竭的患者中，比较了四种具有不同辅助特性的正性肌力药物[一种强心苷（地高辛）、一种α和β肾上腺素能联合激动剂（多巴酚丁胺）、一种β肾上腺素能激动剂（普瑞特罗）和一种磷酸二酯酶抑制剂（氨力农）]单独使用以及随后加用硝酸异山梨酯时的效果。除多巴酚丁胺外，所有药物均降低了升高的左心充盈压；只有地高辛和多巴酚丁胺增加了心排血量指数。除地高辛外，所有药物均降低了全身血管阻力指数；地高辛使用60分钟后出现小动脉收缩反应，α和β肾上腺素能联合刺激（分别为多巴酚丁胺和普瑞特罗）后出现心动过速。加用硝酸异山梨酯可逆转正性肌力药物引起的体动脉压升高，并进一步降低左心充盈压。这些数据表明，在正性肌力化合物缺乏显著的静脉扩张特性时，急性左心室衰竭仅用正性肌力治疗无法降低升高的左心充盈压，联合使用静脉扩张剂可能在血流动力学上更具优势。
